ACC 2013: Study shows time to a treatment a significant factor for in-hospital outcomes of acute heart failure patients

March 9, 2013 – Study results indicate that most patients do receive the first intravenous therapy relatively promptly upon hospital presentation.

In a recent study of older patients who were hospitalized with acute decompensated heart failure (ADHF), researchers have found that having a shorter time from hospital admittance to administration of first intravenous drug therapy was associated with better in-hospital outcomes but not 30-day follow-up outcomes. These results were presented today at the American College of Cardiology Scientific Sessions in San Francisco, CA.

The researchers analyzed records from the Acute Decompensated Heart Failure registry Emergency Module (ADHERE-EM) registry for in-hospital data and used Medicare data from the United States Centers for Medicare & Medicaid Services (CMS) to look for all-cause mortality or readmission in these same AHF patients in the 30 day after hospital discharge. DCRI Fellow Yee Weng Wong, MBBS, FRACP; led this analysis with contributions from Xiaojuan Mi, PhD; Lesley Curtis, PhD; Laura Qualls, MS; and Adrian Hernandez, MD, MHS.

The study, which only looked at ADHF patients aged 65 years and older who were admitted and treated with intravenous drug therapy, showed that delay in treatment administration was associated with a small increase risk of in-hospital death and an increased length of hospital stay. According to Wong, patients hospitalized for AHF usually experience a more insidious onset, getting gradually worse over a series of days. Therefore, a few hours’ delay in treatment is not going to change outcomes as significantly as to patients presented with acute heart attacks.

Wong explained that it is not surprising that delayed treatment did not significantly affect outpatient outcomes since the outcomes of patients outside the hospital are often dictated by the severity of their conditions and their other comorbidities.

He pointed out that the study results indicate that most patients do receive the first intravenous therapy relatively promptly upon hospital presentation, often within the first 4 hours. In addition, a significant proportion of patients also received vasoactive medications during the stay in the emergency department. Some of these observations may have implication on future trial design. For example, future study looking at novel acute treatment in ADHF may need to be administered relatively early during the hospital presentation in order to maximize the probability to detect an efficacy signal.