Outcomes of ambulance arrival vs. self-presentation in acute heart failure: an insight from the heart failure registry in Pakistan

ABSTRACT

Objectives

We aimed to demonstrate the outcomes of various presentations of acute heart failure (AHF), as well as test the generalizability of previous results in routine clinical practice.

Methods

This retrospective cohort study compares two patient groups of AHF: those who self-presented compared to those who used an ambulance. The primary endpoint was the measure of 30-, 180-, and 365-day cardiovascular (CV) mortality after the index hospitalization event. Secondary endpoints included HF rehospitalization within 30 days of enrollment, index hospital stay, and death from any cause during the index hospitalization. The relationship between the two modes of presentation was calculated by multivariate analysis.

Results

A total of 14,454 patients with AHF presented to the emergency department. Patients who presented by ambulance had a higher 30-, 180-, and 365-day mortality than those who self-presented (30-day: 5.57% vs. 3.53%, OR [95% CI]: 0.65 [0.24–0.93], p-value <0.001; 180-day: 11.25% vs. 8.41%, OR [95% CI]: 0.52 [0.34–0.97], p-value = 0.021; and 365-day: 19.25% vs. 15.48%, OR [95% CI]: 0.67 [0.33–0.95], p-value <0.001).

Conclusion

AHF patients who presented via ambulance had a higher 30-, 180-, and 365-day mortality as compared to self-presentation.

KEYWORDS:

• Decompensated heart failure
• coronary artery disease
• ambulance services
• cardiovascular mortality

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

DI Satti: first draft, final draft; T Hussain: first draft, methodology, final draft; S Ahmed: concept, first draft, analysis, final draft, data curation; BH Saqib: first draft; J Malik: final draft, analysis; F Umair: first draft, final draft.

Additional information

Funding

This paper was not funded.