Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: An observational study

Gerben Keijzers, Anne Maree Kelly, Louise Cullen, Sharon Klim, Colin A. Graham, Simon Craig, Win Sen Kuan, Peter Jones, Anna Holdgate, Charles Lawoko, Said Laribi

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Abstract

Objectives: To describe demographic features,assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea. Design: Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM). Setting: 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014. Participants: Patients with an ED diagnosis of heart failure. Outcome measures: Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay (LOS) and mortality). Results: 455 (14.9%) of the 3044 patients had an ED diagnosis of heart failure. Median age was 79 years, half were male and 62% arrived via ambulance. 392 (86%) patients were admitted to hospital. ED diagnosis was concordant with hospital discharge diagnosis in 81% of cases. Median hospital LOS was 6 days (IQR 4-9) and in-hospital mortality was 5.1%. Natriuretic peptide levels were ordered in 19%, with lung ultrasound (<1%) and echocardiography (2%) uncommonly performed. Treatment modalities included non-invasive ventilation (12%), diuretics (73%), nitrates (25%), antibiotics (16%), inhaled â-agonists (13%) and corticosteroids (6%). Conclusions: In the Asia Pacific region, heart failure is a common diagnosis among patients presenting to the ED with a principal symptom of dyspnoea. Admission rates were high and ED diagnostic accuracy was good. Despite the seemingly suboptimal adherence to investigation and treatment guidelines, patient outcomes were favourable compared with other registries.

Original languageEnglish
Article numbere013812
JournalBMJ Open
Volume7
Issue number2
DOIs
Publication statusPublished - 1 Feb 2017

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Dyspnea
Observational Studies
Hospital Emergency Service
Heart Failure
Length of Stay
Hospital Mortality
New Zealand
Patient Outcome Assessment
Noninvasive Ventilation
Natriuretic Peptides
Ambulances
Malaysia
Singapore
Hong Kong
Diuretics
Nitrates
Registries
Echocardiography
Adrenal Cortex Hormones
Epidemiology

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Keijzers, G., Kelly, A. M., Cullen, L., Klim, S., Graham, C. A., Craig, S., ... Laribi, S. (2017). Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: An observational study. BMJ Open, 7(2), [e013812]. https://doi.org/10.1136/bmjopen-2016-013812
Keijzers, Gerben ; Kelly, Anne Maree ; Cullen, Louise ; Klim, Sharon ; Graham, Colin A. ; Craig, Simon ; Kuan, Win Sen ; Jones, Peter ; Holdgate, Anna ; Lawoko, Charles ; Laribi, Said. / Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region : An observational study. In: BMJ Open. 2017 ; Vol. 7, No. 2.
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title = "Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: An observational study",
abstract = "Objectives: To describe demographic features,assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea. Design: Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM). Setting: 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014. Participants: Patients with an ED diagnosis of heart failure. Outcome measures: Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay (LOS) and mortality). Results: 455 (14.9{\%}) of the 3044 patients had an ED diagnosis of heart failure. Median age was 79 years, half were male and 62{\%} arrived via ambulance. 392 (86{\%}) patients were admitted to hospital. ED diagnosis was concordant with hospital discharge diagnosis in 81{\%} of cases. Median hospital LOS was 6 days (IQR 4-9) and in-hospital mortality was 5.1{\%}. Natriuretic peptide levels were ordered in 19{\%}, with lung ultrasound (<1{\%}) and echocardiography (2{\%}) uncommonly performed. Treatment modalities included non-invasive ventilation (12{\%}), diuretics (73{\%}), nitrates (25{\%}), antibiotics (16{\%}), inhaled {\^a}-agonists (13{\%}) and corticosteroids (6{\%}). Conclusions: In the Asia Pacific region, heart failure is a common diagnosis among patients presenting to the ED with a principal symptom of dyspnoea. Admission rates were high and ED diagnostic accuracy was good. Despite the seemingly suboptimal adherence to investigation and treatment guidelines, patient outcomes were favourable compared with other registries.",
author = "Gerben Keijzers and Kelly, {Anne Maree} and Louise Cullen and Sharon Klim and Graham, {Colin A.} and Simon Craig and Kuan, {Win Sen} and Peter Jones and Anna Holdgate and Charles Lawoko and Said Laribi",
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Keijzers, G, Kelly, AM, Cullen, L, Klim, S, Graham, CA, Craig, S, Kuan, WS, Jones, P, Holdgate, A, Lawoko, C & Laribi, S 2017, 'Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region: An observational study' BMJ Open, vol. 7, no. 2, e013812. https://doi.org/10.1136/bmjopen-2016-013812

Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region : An observational study. / Keijzers, Gerben; Kelly, Anne Maree; Cullen, Louise; Klim, Sharon; Graham, Colin A.; Craig, Simon; Kuan, Win Sen; Jones, Peter; Holdgate, Anna; Lawoko, Charles; Laribi, Said.

In: BMJ Open, Vol. 7, No. 2, e013812, 01.02.2017.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Heart failure in patients presenting with dyspnoea to the emergency department in the Asia Pacific region

T2 - An observational study

AU - Keijzers, Gerben

AU - Kelly, Anne Maree

AU - Cullen, Louise

AU - Klim, Sharon

AU - Graham, Colin A.

AU - Craig, Simon

AU - Kuan, Win Sen

AU - Jones, Peter

AU - Holdgate, Anna

AU - Lawoko, Charles

AU - Laribi, Said

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Objectives: To describe demographic features,assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea. Design: Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM). Setting: 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014. Participants: Patients with an ED diagnosis of heart failure. Outcome measures: Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay (LOS) and mortality). Results: 455 (14.9%) of the 3044 patients had an ED diagnosis of heart failure. Median age was 79 years, half were male and 62% arrived via ambulance. 392 (86%) patients were admitted to hospital. ED diagnosis was concordant with hospital discharge diagnosis in 81% of cases. Median hospital LOS was 6 days (IQR 4-9) and in-hospital mortality was 5.1%. Natriuretic peptide levels were ordered in 19%, with lung ultrasound (<1%) and echocardiography (2%) uncommonly performed. Treatment modalities included non-invasive ventilation (12%), diuretics (73%), nitrates (25%), antibiotics (16%), inhaled â-agonists (13%) and corticosteroids (6%). Conclusions: In the Asia Pacific region, heart failure is a common diagnosis among patients presenting to the ED with a principal symptom of dyspnoea. Admission rates were high and ED diagnostic accuracy was good. Despite the seemingly suboptimal adherence to investigation and treatment guidelines, patient outcomes were favourable compared with other registries.

AB - Objectives: To describe demographic features,assessment, management and outcomes of patients who were diagnosed with heart failure after presenting to an emergency department (ED) with a principal symptom of dyspnoea. Design: Planned substudy of the prospective, descriptive cohort study: Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM). Setting: 46 EDs in Australia, New Zealand, Singapore, Hong Kong and Malaysia collected data over 3 72-hour periods in May, August and October 2014. Participants: Patients with an ED diagnosis of heart failure. Outcome measures: Outcomes included patient epidemiology, investigations ordered, treatment modalities used and patient outcomes (hospital length of stay (LOS) and mortality). Results: 455 (14.9%) of the 3044 patients had an ED diagnosis of heart failure. Median age was 79 years, half were male and 62% arrived via ambulance. 392 (86%) patients were admitted to hospital. ED diagnosis was concordant with hospital discharge diagnosis in 81% of cases. Median hospital LOS was 6 days (IQR 4-9) and in-hospital mortality was 5.1%. Natriuretic peptide levels were ordered in 19%, with lung ultrasound (<1%) and echocardiography (2%) uncommonly performed. Treatment modalities included non-invasive ventilation (12%), diuretics (73%), nitrates (25%), antibiotics (16%), inhaled â-agonists (13%) and corticosteroids (6%). Conclusions: In the Asia Pacific region, heart failure is a common diagnosis among patients presenting to the ED with a principal symptom of dyspnoea. Admission rates were high and ED diagnostic accuracy was good. Despite the seemingly suboptimal adherence to investigation and treatment guidelines, patient outcomes were favourable compared with other registries.

UR - http://www.scopus.com/inward/record.url?scp=85014278777&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2016-013812

DO - 10.1136/bmjopen-2016-013812

M3 - Article

VL - 7

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 2

M1 - e013812

ER -