Hospital Outcome and Short-Term Follow-up of Predominatly Elderly Patients Presenting to the Emergency Department with Congestive Heart Failure

Abstract

Purpose - To evaluate the in-hospital (IH) outcome and the short-term follow-up of predominantly elderly patients presenting to an emergency room (ER) with congestive heart failure (CHF). Methods - In an 11 month period, 57 patients presenting to the ER with CHF were included. Mean age was 69±15 years (27 to 94) and 39 (68,4%) were male CHF diagnosis was based on the Boston criteria. We evaluated IH outcome and prognosis in a mean follow-up of 5,7±2,7 months (I to 12). In addition, some mortality predictors and mechanisms of death according on the ACME system were identified. Results - Eight patients (14%) died in the IH period. Modes of death were circulatory failure (CF) in 7, and peri-operative (PO) in one (aortic valve replacement). During follow-up 9 deaths ocurred. Five were due to CF, 2 were sudden and 2 were PO (mitral valve replacement and ventriculectomy). Six-months and 1-year survival rates of the patients who were discharged were 82% and 66%, respectively. Sodium lower than 135mEq/l (p= 0.004) and female gender (p= 0.038) were independent predictors of mortality. Conclusion - Elderly patients with CHF admitted to the ER have high in-hospital and short-term follow up mortalities. The majority die from CF due to worsening heart failure.