patient admission – ABC CARDIOL

ABC

Editorial

In-Hospital Worsening Heart Failure: Can We Predict It At Admission?

Acute decompensated heart failure (ADHF) is a risk marker in the patient’s heart failure (HF) journey. It may be the initial presentation (de novo HF) or an acute exacerbation of chronic HF. Most patients with ADHF present to the emergency department (ED) with congestion and usually respond well to treatment with diuretics. However, some high-risk patients may have a complicated course during hospitalization, including in-hospital worsening HF (WHF), defined as persistent or worsening signs and symptoms requiring an escalation in therapy. Identifying such patients is important since they are at greater risk of in-hospital and post-discharge events.^,

In the early 2000s, ADHF began to attract the attention of many researchers in the field of HF. In that period, a large registry of patients with ADHF – the ADHERE Registry – was set up in the United States of America. The ADHERE Registry gave enormous contributions to the field of ADHF. They taught us about these patients’ clinical characteristics and outcomes, but more importantly, they created prediction rules for patients admitted with ADHF. They initially reported a regression tree analysis, using three simple variables to predict in-hospital mortality – blood urea nitrogen (BUN), creatinine, and systolic blood pressure. Two years later, they reported the value of B-type natriuretic peptide (BNP) in predicting in-hospital mortality. In 2016 they developed and validated a model to predict in-hospital WHF, which included clinical variables (age, heart rate, systolic blood pressure), laboratory tests (BUN, creatinine, serum sodium), biomarkers (BNP and troponin), and the left ventricle ejection fraction (LVEF). Their model had good discrimination, with c-statistics of 0.74 and 0.72 for the derivation and validation cohorts, respectively, as shown in . Nevertheless, discrimination was modest in the external validation cohort (ASCEND-HF study) (c-statistic 0.63).

[…]

Read Full Article

ABC

Artigo Original

Emergency service admission time and in-hospital mortality in acute coronary syndrome

Julio Yoshio Takada et al. Larissa Cardoso Roza Rogério Bicudo Ramos Solange Desiree Avakian … José Antonio Franchini Ramires Antonio de Pádua Mansur

BACKGROUND: The relationship between admission time to an emergency service and in-hospital outcomes in acute coronary syndrome (ACS) is controversial. Admission during off-hours would be associated with worse prognosis. OBJECTIVE: To assess the influence of admission time on prolonged hospitalization and mortality for ACS patients, regarding regular hours (7AM-7PM) and off-hours (7PM-7AM). METHODS: The study assessed prospectively 1,104 consecutive ACS patients. In-hospital mortality and length of hospital stay > 5 days were the outcomes analyzed. RESULTS: Admission during regular hours was greater as compared with that during off-hours (63% vs. 37%; p < 0.001). Unstable angina was more prevalent during regular hours (43% vs. 32%; p 5 days were as follows: age [OR 1.042 (95%CI: 1.025 – 1.058), p < 0.001]; ejection fraction (EF) [OR 0.977 (95%CI: 0.966 – 0.988), p < 0.001]; NSTEMI [OR 1.699 (95%CI: 1.221 – 2.366), p = 0.001]; and smoking [OR 1.723 (95%CI: 1.113 – 2.668), p = 0.014]. Predictive factors for in-hospital mortality were as follows: age [OR 1.090 (95%CI: 1.047 – 1.134), p < 0.001]; EF [OR 0.936 (95%CI: 0.909 – 0.964), p < 0.001]; and surgical treatment [OR 3.781 (95%CI: 1.374 – 10.409), p = 0.01]. CONCLUSION: Prolonged length of hospital stay and in-hospital mortality in ACS patients do not depend on admission time.

Read Full Article

In-Hospital Worsening Heart Failure: Can We Predict It At Admission?

Emergency service admission time and in-hospital mortality in acute coronary syndrome

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)