Objectives To describe demographic features, assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea.
Design Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM).
Setting 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014.
Participants Patients with an ED diagnosis of heart failure.
Outcome measures Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay (LOS) and mortality).
Results 455 (14.9%) of the 3044 patients had an ED diagnosis of heart failure. Median age was 79 years, half were male and 62% arrived via ambulance. 392 (86%) patients were admitted to hospital. ED diagnosis was concordant with hospital discharge diagnosis in 81% of cases. Median hospital LOS was 6 days (IQR 4–9) and in-hospital mortality was 5.1%. Natriuretic peptide levels were ordered in 19%, with lung ultrasound (<1%) and echocardiography (2%) uncommonly performed. Treatment modalities included non-invasive ventilation (12%), diuretics (73%), nitrates (25%), antibiotics (16%), inhaled β-agonists (13%) and corticosteroids (6%).
Conclusions In the Asia Pacific region, heart failure is a common diagnosis among patients presenting to the ED with a principal symptom of dyspnoea. Admission rates were high and ED diagnostic accuracy was good. Despite the seemingly suboptimal adherence to investigation and treatment guidelines, patient outcomes were favourable compared with other registries.
- ACCIDENT & EMERGENCY MEDICINE
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Contributors GK, A-MK, CAG, SC, PJ, AH and SL were involved in conception and design of the research. GK, SK, WSK, CAG, SC and PJ were involved in acquisition of data. GK, A-MK, LC, WSK, CAG and PJ were involved in analysis and interpretation of the data. GK, A-MK and CL were involved in statistical analysis. GK, A-MK, SK and CAG were involved in obtaining funding and supervising the work. GK, A-MK and LC were involved in drafting the manuscript. GK, A-MK, LC, SK, CAG, SC, WSK, PJ, AH, SL and CL were involved in critical revision of the manuscript for important intellectual content. CL was involved in review of statistical reporting. All authors have approved the final manuscript.
Funding This work was supported by a grant from the Queensland Emergency Medicine Research Foundation, grant number EMPJ-108R21-2014.
Competing interests A-MK reports personal fees from AstraZeneca, MSD, Novartis and Churchill Livingstone, outside the submitted work. A-MK has participated in advisory boards for AstraZeneca, MSD and Novartis and delivered educational sessions sponsored by AstraZeneca, outside the submitted work. LC reports personal fees from Novartis and AstraZeneca, grants and personal fees from Abbott Diagnostics, Alere and Siemens, as well as grants from Roche, outside the submitted work. SL reports personal fees from LILLY and SERVIER, outside the submitted work.
Ethics approval All relevant jurisdictions approved the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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