[EAHFE (Epidemiology Acute Heart Failure Emergency) study: analysis of the patients with echocardiography performed prior to an emergency visit due to an episode of acute heart failure]

Abstract

Introduction and objectives: Analyze the clinical profile and short-term evolution of the patients attended in the Spanish Hospital Emergency Services (SHES) due to an episode of acute heart failure (AHF) based on whether these patients had undergone or not an echocardiography and on the ventricular function estimated in said ultrasonography.

Patients and methods: A total of 9 hospitals participated. They consecutively enrolled all the patients diagnosed of AHF during 2 months. Data were collected on the clinical profile and the short-term evolution (intra-hospital mortality and mortality and re-visits at 30 days). The existence of a previous echocardiography was retrospectively investigated and, if it existed, the quantification of the left ventricular ejection fraction (LVEF) as well. The ventricular function was considered to be depressed or conserved according to whether the LVEF was greater or equal to 45% or less than 45%, respectively.

Results: A total of 997 patients were enrolled. An echocardiography was available for 547 patients (54.9%). Of these, the type of ventricular function was known in 476: 273 (57.4%) had depressed function and 203 (42.6%) had conserved function. The patients who did not have an echocardiography were older, with fewer pathological backgrounds. They had less advanced forms of heart disease, used beta blockers less and, were treated less with bolus diuretics in the emergency service. The patients with depressed systolic function were more often males, younger, active smokers, with ischemic heart disease and had signs of left heart failure (orthopnea and paroxysmal nocturnal dyspnea). Less frequently, they were hypertense, with valvular heart disease, with chronic atrial fibrillation and their systolic blood pressure in the Emergency Service was lower. They were directly discharged from the SHES more frequently. Intra-hospital mortality was 5.3%, mortality at 30 days 8.9% and re-visit at 30 days 27.2%. However, no significant differences were found in any of these evolution variables based on the existence or not of an echocardiography or on the type of dysfunction found in it.

Conclusions: The patients who had an episode of AHF did not have any previous echocardiography in a high number of cases. This fact made it necessary in these cases to carry out the therapeutic management in the SHES guided only by the signs and symptoms, such as systolic blood pressure on their arrival to the emergency service. In spite of this, the fact that the functional state of the left ventricular was not known did not affect the intra-hospital mortality, at 30-days and readmission.