AI Article Synopsis
- Acute heart failure (AHF) is critical and requires swift treatment, particularly with loop diuretics, as quicker administration can affect patient outcomes.
- A study called REALITY-AHF analyzed how the timing of administering furosemide (a type of diuretic) influenced in-hospital mortality rates for 1,291 AHF patients.
- Results indicated that patients receiving treatment within 60 minutes had a significantly lower mortality rate (2.3%) compared to those who received it later (6.0%), showing that early intervention is crucial for better survival rates.
Article Abstract
Background: Acute heart failure (AHF) is a life-threatening disease requiring urgent treatment, including a recommendation for immediate initiation of loop diuretics.
Objectives: The authors prospectively evaluated the association between time-to-diuretic treatment and clinical outcome.
Methods: REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) was a prospective, multicenter, observational cohort study that primarily aimed to assess the association between time to loop diuretic treatment and clinical outcome in patients with AHF admitted through the emergency department (ED). Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection. Patients with a D2F time <60 min were pre-defined as the early treatment group. Primary outcome was all-cause in-hospital mortality.
Results: Among 1,291 AHF patients treated with intravenous furosemide within 24 h of ED arrival, the median D2F time was 90 min (IQR: 36 to 186 min), and 481 patients (37.3%) were categorized as the early treatment group. These patients were more likely to arrive by ambulance and had more signs of congestion compared with the nonearly treatment group. In-hospital mortality was significantly lower in the early treatment group (2.3% vs. 6.0% in the nonearly treatment group; p = 0.002). In multivariate analysis, earlier treatment remained significantly associated with lower in-hospital mortality (odds ratio: 0.39; 95% confidence interval: 0.20 to 0.76; p = 0.006).
Conclusions: In this prospective multicenter, observational cohort study of patients presenting at the ED for AHF, early treatment with intravenous loop diuretics was associated with lower in-hospital mortality. (Registry focused on very early presentation and treatment in emergency department of acute heart failure syndrome; UMIN000014105).
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| http://dx.doi.org/10.1016/j.jacc.2017.04.042 | DOI Listing |
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