- 作者：Jiri Karasek ; MD ; karasek@fnkv.cz ; Petr Widimsky ; MD ; PhD ; Petr Ostadal ; MD ; PhD ; Hana Hrabakova ; MD ; Martin Penicka ; MD ; PhD
- 刊名：The American Journal of Emergency Medicine
- 出版年：2012
- 期刊代码：316_07356757
- 类别：med
- 出版时间：June, 2012
- 卷：30
- 期：5
- 页码：695-705
- 文件大小：289 K
Background
Acute heart failure (AHF) is associated with a poor prognosis.Objectives
The objectives of this study are to describe mechanisms of AHF and to identify the predictors for all-cause mortality by patients admitted for hospitalization by emergency departments (EDs) as well as to compare European and American data.
Methods
We designed a prospective registry of consecutively admitted patients for AHF to a high-volume university hospital ED during a 1-year period (n = 202; age, 75 卤 11 years; 51%men; ejection fraction, 38%卤 15%).
Results
The major causes of AHF were coronary artery disease, often with concomitant mitral regurgitation, hypertension, or atrial fibrillation (>90%of cases). At admission, 24.9%of patients had preserved ejection fractions (>50%); and only 7.7%fulfilled the definition of diastolic AHF. The 30-day and long-term mortality (median follow-up, 793 days) were 20.3%and 31.0%, respectively. A low systolic blood pressure (P = .006), reduced ejection fraction (P = .044), and low serum hemoglobin level (P < .01) emerged as the strongest predictors of all-cause mortality. In patients with AHF without acute myocardial infarction (MI) (63.9%), prescription, at discharge, of statins (P < .05) was independently associated with all-cause mortality.
Conclusions
The patient's blood pressure, ejection fraction, and hemoglobin values, at admission, were identified as the strongest predictors of all-cause mortality. In AHF not triggered by acute MI, long-term use of statins may be associated with reduced survival.
The prevalence of diastolic AHF is low. The American AHF population had similar baseline characteristics; needed fewer intensive care unit admissions; had a better 30 days of prognosis, lower incidence of MI, and de novo AHF diagnoses. In a similar subgroup, we observed similar incidences of inotropic support and mechanical ventilation. Our results could not be generalized to all patients with AHF admitted to US EDs.