Outcomes of ambulance arrival vs. self-presentation in acute heart failure: an insight from the heart failure registry in Pakistan

Abstract

Objectives We aimed to demonstrate the outcomes of various presentations of AHF, as well as test the generalizability of previous results in routine clinical practice. Methods This retrospective cohort study compares two patient groups of AHF: those who self-presented compared to those who used an ambulance. The primary endpoint was the measure of 30-,180-,365-days CV mortality after the index hospitalization event. Secondary endpoints included heart failure rehospitalization within 30-days of enrolment, index hospital stay, and death from any cause during the index hospitalization. The relationship between the two modes of presentation was calculated by multivariate analysis. Multivariable logistic regression was applied for primary outcomes. Results A total of 14,454 patients presented to the emergency department with AHF. Patients who presented by ambulance had a higher 30-, 180-, and 365-day mortality than those who self-presented (30-day: 5.57% vs. 3.53%, OR [95% CI]: 0.65 [0.24-0.93], p-value < 0.001; 180-day: 11.25% vs. 8.41%, OR [95% CI]: 0.52 [0.34-0.97], p-value = 0.021; 365-day: 19.25% vs. 15.48%, OR [95% CI]: 0.67 [0.33-0.95], p-value < 0.001). Conclusion Acute heart failure patients who presented via ambulance had a higher 30-, 180-, and 365-day mortality as compared to self-presentation.