Abstract
Chronic heart failure is considered a severe cardiovascular disease seen commonly in the emergency department (ED). Emergency physicians face great challenges in the evaluation of obese chronic heart failure patients due to relatively complicated clinical entities. The aim of this study is to develop an easy and quick scoring system to help bedside evaluation of the severity and predict the length of hospitalization (length of stay) of obese chronic heart failure patients in ED. 26 different variables were analyzed as potential severity risk factors in obese chronic heart failure patients. Adjusted odds ratios were calculated using multivariate logistic regression. A point scoring system was established to predict the length of stay and validated in obese chronic heart failure patients at another facility with similar patient populations. 600 chronic heart failure patients were reviewed including 297 obese and 303 non-obese. Statistically significant difference were found between obese and non-obese chronic heart failure groups (including age 55.08±12.16 vs 58.20±12.38 p=0.001, hypoxia 20.5% vs 13.5% p=0.021, history of diabetes 62.0% vs 38.0% p<0.001, history of hypertension 90.9% vs 81.2% p=0.001, B-type natriuretic peptide level 689.94±711.53 vs 1173.92±1035.72 p<0.001, and using continuous positive airway pressure ventilation in ED 5.72% vs 0.99% p=0.001). In obese chronic heart failure patients, hypoxia (O), having atrial fibrillation with rapid ventricular response upon arrival in ED (A), taking beta blockers chronically (B), tachycardia upon arrival in ED (T), and non-smoker (-S) are considered independent risk factors to affect the length of stay in obese but not in non-obese group. BOAT-S score was developed to predict the length of stay in obese chronic heart failure patients with a sensitivity of 63.5% and a specificity of 90.3%. Additionally, BOAT-S score was validated in another group of obese chronic heart failure patients at similar ED setting with similar sensitivity (66.7%) and specificity (80.0%). Obese chronic heart failure patients are a special population that requires particular attention in terms of their severity evaluation and disposition. Using BOAT-S score may be helpful to predict the length of stay.
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