Abstract
Background
The hemodynamic profile of patients presenting to the emergency department (ED) with
acutely decompensated heart failure (ADHF) provides the basis for initial management.
We characterized the hemodynamic profiles of patients presenting to the ED with ADHF
and their association with treatments and outcomes.
Methods
We conducted a retrospective analysis of the National Hospital Ambulatory Medical
Care Survey (2006-2010) including ED subjects presenting with ADHF. Patients were
classified into 3 groups based on their presenting systolic blood pressure (SBP):
hypertensive (HTN) (SBP, ≥160), normotensive (NT) (SBP, 100-159), or hypotensive (HYPO) (SBP, <100). Univariate and multivariate analyses were used to determine associations between
age, sex, race, and medications administered vs hemodynamic profiles using χ2 test and logistic regression.
Results
There were an estimated 3.4 million ED patient visits for ADHF. Mean age was 69 years,
51% were men, and 65% were white. Hemodynamic profiles at presentation were HTN (32%),
NT (48%), and HYPO (21%). Age, sex, and ethnicity were similar across hemodynamic
profiles. Rates of admission (HTN [78%], NT [75%], and HYPO [72%]; P = .39) and ED mortality (HYPO, 0.8%; HTN and HYPO, 0% each; P = .12) were not associated with hemodynamic group. Although administration of loop
diuretics was similar across groups (approximately 60%-70% each), vasodilator use
(mostly nitroglycerin) was greatest in the HTN group (42%, HTN; 23%, NT; 12%, HYPO;
P < .001).
Conclusions
Of HTN ADHF patients, less than half received vasodilators, and approximately one-third
did not receive diuretics, in the ED. The development of stratified protocols for
therapy based on these profiles should be considered.
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Article Info
Publication History
Published online: December 09, 2013
Accepted:
December 2,
2013
Received in revised form:
November 28,
2013
Received:
November 3,
2013
Footnotes
☆Disclosures: None of the authors have any conflicts of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
