Is Time of the Essence? The Impact of Time of Hospital Presentation in Acute Heart Failure

Cerbin, Lukasz; Ambrosy, Andrew P.; Greene, Stephen J.; Armstrong, Paul W.; Butler, Javed; Coles, Adrian; DeVore, Adam D.; Hernandez, Adrian F.; Metra, Marco; Starling, Randall C.; Tang, W.H. Wilson; Teerlink, John R.; Voors, Adriaan A.; Wu, Angie; O’Connor, Christopher M.; Mentz, Robert J.

doi:10.1016/j.jchf.2018.01.018

Cited by 4 publications

(28 citation statements)

References 28 publications

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“…An analogous analysis of the ASCEND‐HF trial showed lower 180 day cardiovascular mortality among non‐working vs. working hour admission. Still, there were no differences when patients were divided in line with RELAX‐AHF nighttime vs. daytime admission criteria 7 . For the first time, the current analysis from REPORT‐HF showed higher mortality at 1 year follow‐up for patients presenting during non‐working vs. working hours.…”

Section: Discussionmentioning

confidence: 52%

“…In this study, Western European patients were admitted more frequently during non‐working vs. working hours than Eastern European patients. This was also shown in the ASCEND‐HF but not RELAX‐AHF sub‐analysis 7,8 . Regional discrepancies with previous studies may be principally related to the variation of countries included in each region.…”

Section: Discussionmentioning

confidence: 53%

“…However, we should acknowledge considerable differences with previous studies, mainly in time cut‐offs and definitions of short‐term mortality. For example, the sub‐analysis of the ASCEND‐HF trial defined working hours as 9 AM to 5 PM from Monday to Friday, whereas analyses of the GWTG‐HF and the OPTIMIZE‐HF registries used a broader weekend/weekday dichotomous 7,9,13 . Similarly, the ASCEND‐HF analysis reports 30 day mortality.…”

Section: Discussionmentioning

confidence: 99%

“…In acute heart failure (AHF), data remain controversial. AHF patients admitted to hospital during night hours (vs. morning hours) and during non‐working (vs. working hours) tend to be more dyspnoeic, with more severe pulmonary congestion and less peripheral oedema 7–11 . They are also more commonly classified in a lower New York Heart Association (NYHA) class on the days preceding their hospitalization 7–11 .…”

Section: Introductionmentioning

confidence: 99%

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Hospitalization for acute heart failure during non‐working hours impacts on long‐term mortality: the REPORT‐HF registry

Katsanos,

Ouwerkerk,

Farmakis

et al. 2023

ESC Heart Failure

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AimsHospital admission during nighttime and off hours may affect the outcome of patients with various cardiovascular conditions due to suboptimal resources and personnel availability, but data for acute heart failure remain controversial. Therefore, we studied outcomes of acute heart failure patients according to their time of admission from the global International Registry to assess medical practice with lOngitudinal obseRvation for Treatment of Heart Failure.Methods and resultsOverall, 18 553 acute heart failure patients were divided according to time of admission into ‘morning’ (7:00–14:59), ‘evening’ (15:00–22:59), and ‘night’ (23:00–06:59) shift groups. Patients were also dichotomized to admission during ‘working hours’ (9:00–16:59 during standard working days) and ‘non‐working hours’ (any other time). Clinical characteristics, treatments, and outcomes were compared across groups. The hospital length of stay was longer for morning (odds ratio: 1.08; 95% confidence interval: 1.06–1.10, P < 0.001) and evening shift (odds ratio: 1.10; 95% confidence interval: 1.07–1.12, P < 0.001) as compared with night shift. The length of stay was also longer for working vs. non‐working hours (odds ratio: 1.03; 95% confidence interval: 1.02–1.05, P < 0.001). There were no significant differences in in‐hospital mortality among the groups. Admission during working hours, compared with non‐working hours, was associated with significantly lower mortality at 1 year (hazard ratio: 0.88; 95% confidence interval: 0.80–0.96, P = 0.003).ConclusionsAcute heart failure patients admitted during the night shift and non‐working hours had shorter length of stay but similar in‐hospital mortality. However, patients admitted during non‐working hours were at a higher risk for 1 year mortality. These findings may have implications for the health policies and heart failure trials.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hospitalization for acute heart failure during non‐working hours impacts on long‐term mortality: the REPORT‐HF registry

Katsanos,

Ouwerkerk,

Farmakis

et al. 2023

ESC Heart Failure

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“…Most recently, a sub-analysis from ASCEND-AF showed that patients who presented during off hours profit more than do others from nesiritide. 17 In our study, we could show that NPs have a very strong prognostic impact, which is not only related to the diagnosis of AHF. Specifically, patients with ACS and COPD/pneumonia had the highest mortality when MR-proANP was >300 pmol/L.…”

Section: Figurementioning

confidence: 47%

Early identification of acute heart failure at the time of presentation: do natriuretic peptides make the difference?

et al. 2018

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BackgroundThe early identification of patients with acute heart failure (AHF) is challenging as many other diseases lead to a clinical presentation with dyspnea.AimThe aim of the study was to evaluate the impact of natriuretic peptides at common HF study cut‐offs on the diagnosis of patients with dyspnea at admission.Methods and resultsFor this post hoc analysis, we analysed n = 726 European Union (EU) patients from the prospective BACH (Biomarkers in Acute Heart Failure) study. Cut‐offs were 350 ng/L (BNP), 300 pmol/L [pro‐atrial natriuretic peptide (proANP)], and 1800 ng/L (NT‐proBNP). These cut‐offs had equivalent 90 days' mortality in the EU cohort of BACH. We analysed the effect of selection using these cut‐offs on the prevalence of the gold standard diagnoses made in the BACH study and the respective mortality. The prevalence of AHF is increased from 47.5 to 75.6% (NT‐proBNP criteria) up to 79.7% (BNP criteria). With the use of the proANP criteria, 90 days' mortality of patients with AHF rose from 14 to 17% (P = 0.029). In the group with no‐AHF diagnoses, mortality rose from 10 to 25% (P < 0.001).ConclusionsThe prevalence of patients with the gold standard diagnoses of AHF among those presenting with dyspnea to the emergency department is significantly increased by the use of natriuretic peptides with common cut‐offs used in prospective HF studies. Nevertheless, in the selected groups, patients with no AHF diagnosis have the highest mortality, and therefore, the addition of a natriuretic peptide alone is insufficient to start specific therapies.

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A Novel In-hospital Congestion Score to Risk Stratify Patients Admitted for Worsening Heart Failure (from ASCEND-HF)

Masson

Ambrosy

Kheder

et al. 2020

J. of Cardiovasc. Trans. Res.

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Is Time of the Essence? The Impact of Time of Hospital Presentation in Acute Heart Failure

Abstract: In this AHF trial, patients admitted during off hours exhibited a distinct clinical profile, experienced greater dyspnea relief, and had lower post-discharge mortality than regular-hour patients. These findings have implications for future AHF trials.

Cited by 4 publications

References 28 publications

Hospitalization for acute heart failure during non‐working hours impacts on long‐term mortality: the REPORT‐HF registry

Hospitalization for acute heart failure during non‐working hours impacts on long‐term mortality: the REPORT‐HF registry

Early identification of acute heart failure at the time of presentation: do natriuretic peptides make the difference?

A Novel In-hospital Congestion Score to Risk Stratify Patients Admitted for Worsening Heart Failure (from ASCEND-HF)

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