Guidelines recommend immediate treatment for patients presenting to the emergency department (ED) with acute heart failure (AHF), but is the time to diuretic initiation a strong predictor of outcome — or even a target akin to “door-to-balloon time” in ST-segment elevation myocardial infarction? Dr.Park JJ, Kim SH, Oh IY, et al.conducted a large prospective cohort Study to evaluate the impact of door-to-diuretic (D2D) time on mortality in patients with acute heart failure (AHF) who were presenting to an emergency department (ED).The researchers found that D2D time was not associated with clinical outcomes in patients with AHF who were presenting to an ED.The study has been published in Journal of American College of Cardiology, Heart Failure.
The investigators included patients who received intravenous diuretic agents within 24 hours after ED arrival in the Korea Acute Heart Failure registry, which enrolled 5,625 consecutive patients hospitalized for AHF. Early and delayed groups were defined as D2D time ≤60 minutes and D2D time >60 minutes, respectively. The primary outcomes were in-hospital death and post-discharge death at 1 month and 1 year on the basis of D2D time. A multivariable logistic regression and Cox proportional hazards regression models were used to determine the independent effect of D2D time on in-hospital and post-discharge outcomes, respectively.
In a total of 2,761 patients met the inclusion criteria and were enrolled. The median D2D time was 128 minutes (interquartile range, 63-243 minutes), and 663 (24%) patients belonged to the early group. The baseline characteristics were similar between the groups. The rate of in-hospital death did not differ between the groups (5.0% vs. 5.1%; p > 0.999), nor did the postdischarge 1-month (4.0% vs. 3.0%; log-rank p = 0.246) and 1-year (20.6% vs. 19.3%; log-rank p = 0.458) mortality rates. The Get With the Guidelines-Heart Failure risk score was calculated for each patient. In multivariate analyses with adjustment for getting With the Guidelines-Heart Failure risk score and other significant clinical covariates and propensity-matched analyses, D2D time was not associated with clinical outcomes.
The authors, therefore, concluded that D2D time was not associated with clinical outcomes in a large prospective cohort of patients with AHF who were presenting to an ED.This study reports that there was no difference in the in-hospital and post-discharge outcomes between AHF patients in the early and delayed diuretic groups. In the wake of contradictory findings in a previous study, the definitive effects of earlier diuretic therapy on outcomes need to be investigated in prospective randomized clinical studies.
For further reference log on to : DOI: 10.1016/j.jchf.2017.12.017
Dr. Kamal Kant Kohli
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