Objectives The purpose of this study was to assess the clinical characteristics, treatments, and prognosis of acute heart failure (AHF) in the emergency department.
Methods A prospective, cohort, multicentre, non-interventional registry study of consecutive patients with AHF who visited in 14 emergency departments was conducted in Beijing. We collected baseline and current AHF episode data from March 2011 to March 2012.
Results A total of 3346 cases of AHF patients included in the study. The mean age was 67 ± 16 years, 58.3% were male, and 97.3% were Han race. The most common comorbid conditions were diabetes (996 cases, 73%), pulmonary disease (757 cases, 22.6%), chronic renal insufficiency (561 cases, 16.8%) and thyroid disease (89 cases, 2.7%). The presenting sings and symptoms which including chest distress/shortness of breath (3257 cases, 97.3%), fatigue (2433 cases, 72.7%), paroxysmal nocturnal dyspnea (2178 cases, 65.1%), orthopnea (1749 cases, 52.3%), oedema of lower trunk (1900 cases, 56.8%) and bloating and ascites (820 cases, 4.5%) were recorded. Patients with NYHA class, II, III and IV were 79 cases (2.4%), 341 cases (10.2%), 1131 cases (33.8%) and 1785 cases (53.3%), respectively. A history of coronary artery disease was common (1738 cases, 57%) in the registry patients, which including 936 cases of angina, 394 cases of acute myocardial infarction (Killips class III and IV were 102 cases and 80 cases, respectively), 721 cases of old myocardial infarction and 45 cases of ventricular aneurysm. A history of hypertension (1974 cases, 59%) was commonly present as well. Other important conditions included history of cardiomyopathy (588 cases, 17.6%) and valvular heart disease (422 cases, 12.6%). In the study, 1378 cases of patients with smoking history, which accounting for 41.2%, and 826 patients with history of drinking (24.7%). Among the enrolled patients, acute left-side heart failure were 2147 cases (64.2%), acute right-side heart failure were 191 cases (5.7%) and the whole heart failure 1008 cases (30.1%). The medication profiles in the emergency department on admission were also recorded. Intravenous diuretic therapy, oral diuretic therapy, vasodilator, bronchial spasmolytic, antisterone and beta-blockers were noted in 78.8%, 41.1%, 74.6%, 39.2%, 33.3% and 30.5% of the registrants, respectively. Digoxin (24.5%), inotropic agents (23.4%), ACE inhibitor (19.1%), calcium channel blockers (9.6%), Angiotensin II receptor blocker (6.9%) were not common at present. Morphine was noted in 5.2% of registrants. The mortality in the emergence department was 3.7% and discharge voluntarily during therapy due to the deteriorating condition was 6.9%. Among the other patients, 1134 cases of patients (33.9%) were improved and discharged, and 1855 cases (55.4%) were hospital admission.
Conclusions In the emergency department, the most common comorbid conditions of AHF were diabetes. The presenting sings and symptoms were included chest distress/shortness of breath, fatigue and paroxysmal nocturnal dyspnea. More than half of the patients were NYHA class IV. Acute left-side heart failure remained the most common type of heart failure. A history of coronary artery disease was common in the registry patients. The mortality in the emergence department was 3.7%. However, the medication profiles of AHF still had a certain gap compared with international guidelines for heart failure in the emergency department.