1- and 5-year outcomes of heart failure patients with reduced and preserved ejection fraction after acute decompensation according to the final destination after emergency department care

Abstract

Outcome of acute heart failure (AHF) patients according to the final destination after emergency department (ED) has been poorly studied with contradictory results. To compare long-term outcomes after an episode of acute heart failure (AHF) in patients according to their destinations after ED. OFICA (Observatoire Francais de l’Insuffisance Cardiaque Aigue) is a French snapshot registry of all patients with ongoing hospitalization for AHF in a nationwide and representative sample of 170 French hospitals. One thousand six hundreds and fifty-seven patients were included the 12th of March, 2009. Various data were collected including the final destination after ED and patients were followed-up for death as primary outcome. Hazard ratios were calculated for patients admitted in geriatric departments and other wards then compared with those hospitalized in cardiology. P < 0,05 was considered significant. Mean age was 76,0 ± 13,2 y with a sex-ratio close to 1. Overall, the small number of AHF patients referred from the ED to a cardiology ward was 19% with more frequently HF REF. Besides, AHF patients admitted in geriatric unit were older (p < 0,001), more frail (high rates of dementia and low weight; P < 0,001 and P = 0,042) with delayed length of stay ( P = 0,003). It was found that while these patients had a similar 30-day and 1-year mortality (OR = 1,05; CI 95% 0,7–1,59; P = 0,8), 5-year mortality was higher in geriatric patients (HR 1,71; CI 95% 1,26–2,32; P = 0,029) compared with cardiology even after adjustment for age. While patients have similar 1-year outcomes irrespective of the destination after ED care for an AHF episode, those initially admitted in geriatrics present worse 5-year outcomes when managed by non-cardiology departments, despite adjustment for different clinical patient profiles. Reasons for this heterogeneous specialty-related performance should be investigated.