Practice patterns and outcomes in patients presenting to the emergency department with acute heart failure

Heart failure (HF) is a common emergency depart-ment (ED) presentation and a leading reason for hospitalization. Canadian practice patterns for the management of acute HF have not been well described.

To describe current treatment patterns of patients present-ing to the ED with acute HF and investigate whether these treatments influenced outcomes.

A health record review was performed in a 30% random sample of all patients who presented to six EDs in the Capital Health Region (Edmonton, Alberta) with a most responsible diagnosis of acute HF from April 2002, to March 2003.

A total of 448 patients (45% women) with a mean (+/- SD) age of 75.3+/-11.2 years were included. Comorbidities included hypertension (55%), coronary artery disease (39%) and previous myocardial infarction (38%). In the first 72 h, patients were most commonly treated with intra-venous furosemide (48%), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (45%), oral furosemide (42%) and salbuta-mol (38%). Fifty-four per cent of patients were admitted to the hospital, and 20% died or were readmitted within 30 days. Multivariate logistic regression analysis revealed age, history of HF, history of angioplasty and oxygen administration in the ED as independent predictors of death or readmission at 30 days. No medications were associated with decreased readmission or death.

The current treatment patterns for acute HF are mostly symptomatic. Proven efficacious HF therapies remain underused. Future research should focus on the integration of disease management, identifying predictors of admission and readmission, and treatments to reduce rehospitalization.