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Is Time of the Essence? The Impact of Time of Hospital Presentation in Acute Heart Failure: Insights From ASCEND-HF Trial.

Publication ,  Journal Article
Cerbin, LP; Ambrosy, AP; Greene, SJ; Armstrong, PW; Butler, J; Coles, A; DeVore, AD; Ezekowitz, JA; Hernandez, AF; Metra, M; Starling, RC ...
Published in: JACC Heart Fail
April 2018

OBJECTIVES: As the largest acute heart failure (AHF) trial conducted to date, the global ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial database presented an opportunity to systematically describe the relationship among time of hospital presentation, clinical profile, inpatient management, and outcomes among patients admitted with AHF. BACKGROUND: Time of hospital presentation has been shown to impact outcomes among patients hospitalized with many conditions. However, the association among time of presentation and patient characteristics, management, and clinical outcomes among patients hospitalized with AHF has not been well characterized. METHODS: A post hoc analysis of the ASCEND-HF trial was performed, which enrolled 7,141 patients hospitalized for AHF. Patients were divided based on when they presented to the hospital; regular hours were defined as 9 am to 5 pm, Monday through Friday, and off hours were defined as 5 pm to 9 am, Monday through Friday and weekends. Clinical characteristics and outcomes were compared by time of presentation. RESULTS: Overall, 3,298 patients (46%) presented during off hours. Off-hour patients were more likely to have orthopnea (80% vs. 74%, respectively) and rales (56% vs. 49%, respectively) than regular-hour patients. Off-hour patients were more likely to receive intravenous (IV) nitroglycerin (18% vs. 11%, respectively) and IV loop diuretics (92% vs. 86%, respectively) as initial therapy and reported greater relief from dyspnea at 24 h (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.04 to 1.24; p = 0.01) than regular-hour patients. After adjustment, off-hour presentation was associated with significantly lower 30-day mortality (OR: 0.74; 95% CI: 0.57 to 0.96; p = 0.03) and 180-day mortality (hazard ratio [HR]: 0.82; 95% CI: 0.72 to 0.94; p = 0.01) but similar 30-day rehospitalization rates (p = 0.40). CONCLUSIONS: 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.

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

April 2018

Volume

6

Issue

4

Start / End Page

298 / 307

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Time Factors
  • Sodium Potassium Chloride Symporter Inhibitors
  • Respiratory Sounds
  • Proportional Hazards Models
  • Prognosis
  • Posture
  • Patient Readmission
  • Nitroglycerin
  • Mortality
 

Citation

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Cerbin, L. P., Ambrosy, A. P., Greene, S. J., Armstrong, P. W., Butler, J., Coles, A., … Mentz, R. J. (2018). Is Time of the Essence? The Impact of Time of Hospital Presentation in Acute Heart Failure: Insights From ASCEND-HF Trial. JACC Heart Fail, 6(4), 298–307. https://doi.org/10.1016/j.jchf.2018.01.018
Cerbin, Lukasz P., Andrew P. Ambrosy, Stephen J. Greene, Paul W. Armstrong, Javed Butler, Adrian Coles, Adam D. DeVore, et al. “Is Time of the Essence? The Impact of Time of Hospital Presentation in Acute Heart Failure: Insights From ASCEND-HF Trial.JACC Heart Fail 6, no. 4 (April 2018): 298–307. https://doi.org/10.1016/j.jchf.2018.01.018.
Cerbin LP, Ambrosy AP, Greene SJ, Armstrong PW, Butler J, Coles A, et al. Is Time of the Essence? The Impact of Time of Hospital Presentation in Acute Heart Failure: Insights From ASCEND-HF Trial. JACC Heart Fail. 2018 Apr;6(4):298–307.
Cerbin, Lukasz P., et al. “Is Time of the Essence? The Impact of Time of Hospital Presentation in Acute Heart Failure: Insights From ASCEND-HF Trial.JACC Heart Fail, vol. 6, no. 4, Apr. 2018, pp. 298–307. Pubmed, doi:10.1016/j.jchf.2018.01.018.
Cerbin LP, Ambrosy AP, Greene SJ, Armstrong PW, Butler J, Coles A, DeVore AD, Ezekowitz JA, Hernandez AF, Metra M, Starling RC, Tang W, Teerlink JR, Voors AA, Wu A, O’Connor CM, Mentz RJ. Is Time of the Essence? The Impact of Time of Hospital Presentation in Acute Heart Failure: Insights From ASCEND-HF Trial. JACC Heart Fail. 2018 Apr;6(4):298–307.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

April 2018

Volume

6

Issue

4

Start / End Page

298 / 307

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Time Factors
  • Sodium Potassium Chloride Symporter Inhibitors
  • Respiratory Sounds
  • Proportional Hazards Models
  • Prognosis
  • Posture
  • Patient Readmission
  • Nitroglycerin
  • Mortality