The Emergency Department Arrival Mode and Its Relations to ED Management and 30-Day Mortality in Acute Heart Failure: An Ancillary Analysis From The EURODEM Study

Abstract Background: Acute heart failure patients are often encountered in emergency departments from 11% to 57 % using emergency medical services. Our aim was to evaluate the association of emergency department arrival mode with acute heart failure patients’ emergency department management and short-term outcomes. Methods: This was a sub-analysis of the European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from 66 European emergency departments. Patients with emergency department diagnosis of acute heart failure were categorized into two groups: those using emergency medical services and those self-presenting (non- emergency medical service patients). The independent association between emergency medical services use and 30-day mortality was evaluated with logistic regression. Results: Of the 500 acute heart failure patients, 309 (61.8 %) arrived at emergency department by emergency medical services. They were older (median age 80 vs. 75 years, p<0.001) and had more dementia (18.7 % vs. 7.2 %, p<0.001). On admission, emergency medical service patients had more often confusion (43 (14.2 %) vs. 4 (2.1 %), p<0.001) and higher respiratory rate (24/min vs. 21/min, p=0.014; respiratory rate > 30/min in 17.1 % patients vs. 7.5 %, p=0.005). The only difference in emergency department management appeared in the use of ventilatory support: 78.3 % of emergency medical services patients vs. 67.5% of non- emergency medical services patients received oxygen, p=0.007, non-invasive ventilation was administered to 12.5 % of emergency medical service patients vs. 4.2% non- emergency medical service patients, p=0.002. Emergency medical service patients were more often hospitalized (82.4 % vs. 65.9 %, p<0.001). The use of emergency medical services was an independent predictor of 30-day mortality (OR=2.96, 95% CI 1.27-6.92, p=0.012)Conclusion: Most acute heart failure patients arrive at emergency department by emergency medical services. These patients suffer from more severe respiratory distress and receive more often ventilatory support. Emergency medical service use is an independent predictor of 30-day mortality.