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Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: an observational study.

Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: an observational study.
Author Information (click to view)

Keijzers G, Kelly AM, Cullen L, Klim S, Graham CA, Craig S, Kuan WS, Jones P, Holdgate A, Lawoko C, Laribi S,


Keijzers G, Kelly AM, Cullen L, Klim S, Graham CA, Craig S, Kuan WS, Jones P, Holdgate A, Lawoko C, Laribi S, (click to view)

Keijzers G, Kelly AM, Cullen L, Klim S, Graham CA, Craig S, Kuan WS, Jones P, Holdgate A, Lawoko C, Laribi S,

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BMJ open 2017 02 287(2) e013812 doi 10.1136/bmjopen-2016-013812
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.

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