Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort

摘要: OBJECTIVES We investigated the natural history of patients after a first episode acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: frequency ED visits and hospitalisations, departments admitting during subsequent factors associated with difficult disease control. METHODS AND RESULTS included consecutive diagnosed FEAHF (either or without previous diagnosis) in four EDs 5 months three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics index event were prospectively recorded, all post-discharge hospitalisations [related/unrelated to (AHF)], as well involved retrospectively ascertained. 'Uncontrolled disease' year considered if attended at (≥ 3 times) hospitalised (≥ 2 for AHF died. Overall, 505 followed mean 2.4 years. In-hospital mortality 7.5%. Among 467 discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5-4.4], 421 (90%) revisited (2342 visits; 42.4% hospitalisation, 34.0% AHF-related) 357 (77%) (1054 hospitalisations; 94.1% through ED, 51.4% AHF-related). AHF-related mainly internal medicine (28.0%), short-stay unit (26.3%), cardiology (20.8%), geriatrics (14.1%). Only 47.4% same FEAHF, involvement significantly increased (P = 0.01). Uncontrolled observed 31% patients, which independently related age > 80 years [odds ratio (OR) 1.80, CI 1.17-2.77], systolic blood pressure < 110 mmHg arrival (OR 2.61, 1.26-5.38) anaemia 2.39, 1.51-3.78). CONCLUSION In present aged cohort from Barcelona, Spain, showed patterns hospital involvement. Advanced age, low uncontrolled debut.