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Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: an observational study
  1. Gerben Keijzers1,2,3,
  2. Anne-Maree Kelly4,
  3. Louise Cullen5,6,
  4. Sharon Klim7,
  5. Colin A Graham8,
  6. Simon Craig9,10,11,
  7. Win Sen Kuan12,13,
  8. Peter Jones14,
  9. Anna Holdgate15,16,
  10. Charles Lawoko17,
  11. Said Laribi18
  1. 1Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
  2. 2School of Medicine, Bond University, Gold Coast, Queensland, Australia
  3. 3School of Medicine, Griffith University, Gold Coast, Queensland, Australia
  4. 4Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine Australia and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
  5. 5Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  6. 6Faculty of Medicine, University of Queensland and Faculty of Heath, Queensland University of Technology, Herston, Queensland, Australia
  7. 7Joseph Epstein Centre for Emergency Medicine Research @ Western Health, Sunshine, Queensland, Australia
  8. 8Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
  9. 9Department of Emergency, Monash Medical Centre, Clayton, Victoria, Australia
  10. 10School of Clinical Sciences, Monash University, Clayton, Australia
  11. 11Murdoch Children's Research Institute, Parkville, Victoria, Australia
  12. 12Department of Emergency Medicine, National University Health System, Singapore, Singapore
  13. 13Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  14. 14Department of Emergency Medicine, Auckland City Hospital, Auckland, New Zealand
  15. 15Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
  16. 16University of New South Wales (Southwest Clinical School), Sydney, New South Wales, Australia
  17. 17Director, Industry Doctoral Training Centre, ATN Universities, Australia
  18. 18Department of Emergency Medicine, Tours University Hospital, Paris, France
  1. Correspondence to Dr Gerben Keijzers; Gerben.Keijzers{at}health.qld.gov.au

Abstract

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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Footnotes

  • 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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