ASSOCIATION BETWEEN CLUSTERED EMERGENCY ROOM VISITS AND OUTCOMES FOLLOWING AN ADMISSION FOR ACUTE DECOMPENSATED HEART FAILURE: A POPULATION-BASED STUDY

Abstract Background Patients with acute decompensated heart failure (ADHF) are at high risk of recurrent hospitalisations and death. In-hospital initiation of sacubitril/valsartan (S/V) reduced the risk for HF re-hospitalisation by 44% compared to enalapril in the PIONEER-HF study during the 8-week follow-up period. We aimed to describe the pattern of readmissions and their causes in the TRANSITION study, which randomised participants to pre-discharge or post-discharge initation of S/V. Methods TRANSITION (NCT02661217) was a randomised, open-label study comparing S/V initiation pre- vs. post-discharge (1–14 days) in haemodynamically stabilised patients with HF with reduced ejection fraction, admitted for ADHF. The primary endpoint was the proportion of patients achieving 97/103 mg S/V twice daily at 10 weeks post-randomisation. Information on rehospitalisation was collected throughout the study up to 26 weeks. Results A total of 493 patients received S/V in the pre-discharge arm and 489 patients in the post-discharge arm. Readmissions due to any cause were reported in 9.7% and 18.1% in the pre-discharge arm vs. 10.6% and 21.3% in the post-discharge arm within 30 days, and 10 weeks respectively. During the 26-weeks follow-up, all-cause readmission was reported in 34.5% of patients in the pre-discharge arm vs. 34.6% in the post-discharge arm. Median time to first rehospitalisation was 67 days in the pre-discharge arm (IQR: 26–110 days) and 50 days (IQR: 23–108 days) in the post-discharge arm. At least one HF hospitalisation was reported in 7.5% of patients in the pre-discharge arm and 7.4% in the post-discharge arm during 10 weeks and in 11.8% and 12.3% of patients, respectively, during 26 weeks of follow-up. Median duration of HF readmission was 7 days (IQR: 4–11 days) in the pre-discharge group and 6.5 days (IQR: 6.5–10 days) in the post-discharge arm. In total 2.6% and 5.5% patients in pre-discharge arm and 3.9% and 7% in the post-discharge arm visited an emergency room during 10 weeks and 26 weeks, respectively. Conclusions Initiation of S/V in patients hospitalised for ADHF either before or shortly after discharge, results in comparable rates of all cause and HF rehospitalisations, as well as emergency room visits without hospital admission over the 26 week follow-up period. HF re-hospitalisations rates at 10 weeks in TRANSITION are in line with the 8% in S/V arm reported in PIONEER-HF during the 8-weeks follow-up. Acknowledgement/Funding The TRANSITION study was funded by Novartis

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Emergency room visits for respiratory diseases associated with ambient fine particulate matter in Taiwan in 2012: A population-based study

Atmospheric Pollution Research ◽

10.1016/j.apr.2016.11.008 ◽

2017 ◽

Vol 8 (3) ◽

pp. 465-473 ◽

Cited By ~ 7

Author(s):

Su-Lun Hwang ◽

Yu-Ching Lin ◽

Su-Er Guo ◽

Miao-Ching Chi ◽

Chiang-Ting Chou ◽

...

Keyword(s):

Particulate Matter ◽

Emergency Room ◽

Respiratory Diseases ◽

Fine Particulate Matter ◽

Population Based ◽

Emergency Room Visits ◽

Population Based Study ◽

Fine Particulate

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Disability is associated with emergency room visits in the elderly: a population-based study

Aging Clinical and Experimental Research ◽

10.1007/s40520-015-0324-5 ◽

2015 ◽

Vol 27 (5) ◽

pp. 663-671 ◽

Cited By ~ 2

Author(s):

Alice Laudisio ◽

Emanuele Marzetti ◽

Francesco Franceschi ◽

Roberto Bernabei ◽

Giuseppe Zuccalà

Keyword(s):

Emergency Room ◽

The Elderly ◽

Population Based ◽

Emergency Room Visits ◽

Population Based Study

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Abstract P013: Prevalence and Outcomes of Anemia in Patients Hospitalized with Acute Decompensated Heart Failure: The ARIC Study Community Surveillance

Circulation ◽

10.1161/circ.127.suppl_12.ap013 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Melissa Caughey ◽

Loehr Laura ◽

Christy Avery ◽

Hanyu Ni ◽

Brad Astor ◽

...

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Ejection Fraction ◽

Acute Decompensated Heart Failure ◽

Length Of Hospital Stay ◽

Decompensated Heart Failure ◽

Population Based ◽

Reduced Ejection Fraction ◽

Physician Review ◽

Aric Study

Background: Anemia has been associated with increased mortality in heart failure patients. The prevalence and outcomes of anemia in patients hospitalized with acute decompensated heart failure (ADHF) in population-based settings are unknown. Methods: Hospitalizations related to heart failure among black and white residents 55 years and older were sampled by stratified design from 4 US communities (total population age 55+ =177,000), January 1, 2005 -December 31,2008 in the Atherosclerosis Risk in Communities (ARIC) Study. Events were validated by physician review of medical records, and linked to mortality files. Those classified as definite or probable ADHF were included in the analysis; chronic, stable heart failure and hospitalizations not for heart failure were excluded. ADHF was further classified as heart failure with preserved (≥50%) or reduced (<50%) ejection fraction. Laboratory values were abstracted from the hospital record. Anemia was defined by WHO guidelines (< 12 g/dL for women; < 13 g/dL for men), using the lowest hemoglobin. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-Epi formula using serum creatinine. Length of stay and mortality outcomes were analyzed by linear and logistic regression, respectively. All analyses were weighted to account for the sampling design and adjusted for race, age, sex, eGFR and smoking. Results: Over four years, 13,554 (weighted) hospitalized events for definite or probable ADHF occurred, based on 2,804 sampled events. Comorbidities of ADHF included: hypertension (84%), coronary heart disease (55%), chronic bronchitis or COPD (34%), diabetes (48%), and chronic kidney disease (eGFR < 60 mL/min/1.73m 2 ) (73%). Prevalence of anemia was 77% (95%CI: 75-79%) overall and did not differ by race (p=0.6), gender (p=0.1) or by subtype of heart failure based on preserved or reduced ejection fraction (p=0.09). Anemia was more common in patients over age 75 (80%; 95%CI: 78-83%) than patients aged 55-74 (73%; 95% CI: 70-76%); p<.0001. Anemia was associated with an increased length of stay by 3.6 (95%CI: 3.0-4.3) days, and with 1-year mortality (OR=1.3, 95%CI: 1.0-1.8). In a subset of ADHF hospitalizations (N=7,989; 59%) with two hemoglobin values, anemia prevalence was 84% (95%CI:82-86%) by the lowest hemoglobin, improving to 72% (95%CI: 70-75%) by the last documented hemoglobin. Anemia resolved over the course of the hospitalization for 15% of patients; more commonly for women than men (18% vs. 11%; p=.002). Conclusion: Among patients hospitalized for ADHF in these 4 US areas, anemia was common, particularly for those over age 75, and was associated with a longer length of hospital stay and higher 1-year mortality.

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