The profile of patients with acute heart failure managed in pre‑hospital setting

Czech version

Authors: J. Svoboda ¹; M. Felšöci ^2,3; S. Littnerová ⁴; J. Pařenica ^2,3; M. Pavlušová ²; J. Jarkovský ⁴; J. Špinar ^2,3
Authors‘ workplace: Zdravotnická záchranná služba Jihomoravského kraje, p. o., Brno ¹; Interní kardiologická klinika LF MU a FN Brno ²; Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně ³; Institut biostatistiky a analýz, LF a PřF MU, Brno ⁴
Published in: Kardiol Rev Int Med 2014, 16(5): 386-390
Category: Cardiology Review

Overview

Purpose:
To describe the profile and management of patients with acute heart failure (AHF) in pre‑hospital care in the Czech Republic.

Methods:
Registry data of the Emergency Medical System (EMS) of the South Moravian region of Czech Republic were used. Patients with suspected AHF were enrolled consecutively during the period of January 2010– December 2011. Excluded were patients who died or had cardiac arrest before the arrival of EMS and those who presented with dyspnea of dominantly extra- cardiac etiology. We compared patients who were transported to the hospital with those treated in an outpatient setting. Overall mortality within the first 30 days after the initial EMS contact was assessed as a main endpoint.

Results:
From the 131,798 of patients who called EMS, 1,964 (1.5%) of cases were suspected of having AHF. The diagnosis of AHF was determined in 1,310 patients who were transported to the hospital; 35 were treated in Outpatients. The mean age of the study population was 78 years, the most common comorbidity was hypertension (67.0%) and almost one half of the study population had signs of pulmonary edema before being admitted to hospital (46.4%). Patients not transported to hospital were more frequently of male gender (71.4% vs. 49.1%), with lower incidence of comorbid conditions and did not have signs of respiratory distress (oxygen saturation 96% vs. 87% in those transported to the hospital; no signs of pulmonary edema). The most common drug used in pre‑hospital care in patients with suspected AHF was furosemide (74.0% patients). The 30- day mortality rate of the whole study population reached 20.7%.

Conclusion:
AHF represents 1.5% of all emergency calls due to acute symptoms. The vast majority of the patients are transported to the hospital with the assumption of hospitalization. Early mortality rates of these patients are high.

Keywords:
acute – heart failure – survival – emergency medical system

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