Relationship between the type of hospital and its care volume in the emergency room and the management of acute heart failure in the emergency room

Aim. To investigate whether the type of hospital or the volume of patients attended by the emergency department (ED) intervenes in the diagnostic and therapeutic management of acute heart failure (AHF).Method. Thirty-six EDs that had included patients with AHF in the EAHFE 5-6-7 registries participated. Three types of hospital were distinguished (high technology/reference/regional) and three EDs by care volume (high/medium/low). We analyzed 9 parameters related to diagnostic management and 8 to therapeutic management, and investigated whether there was an association with the type of hospital or ED. The associations were adjusted for differences in the baseline characteristics of the patients and the AHF episode, type of hospital and ED, and by center.Results. A total of 10,869 patients were analyzed (median age: 83 years, women: 55%; high-tech/reference/regional hospitals: 68%/16%/16%; ED with high/medium/low volume: 76%/17%/7%). Blood pressure, heart rate, pulse oximetry, chest X-ray, electrocardiogram, and laboratory tests were determined in >95% of patients, but respiratory rate, natriuretic peptide, and troponin were determined in only 71%, 70%, and 54%, respectively. The regional hospitals (as opposed to high technology) determined more vital signs and performed electrocardiograms and blood tests, and less troponin and natriuretic peptide. The EDs with low activity (versus high activity) measured respiratory rate less frequently, performed fewer electrocardiograms and more laboratory tests, although they measured troponin less frequently. The most frequent therapeutic management included IV (intravenous) diuretic (85%), oxygen therapy (68%), and hospitalization (74%), while IV nitroglycerin (8.4%) and non-invasive ventilation (NIV, 6%) were infrequent, morphine (5%) and inotrope/ vasopressor (1%). The district hospitals used more frequently oxygen therapy, NIV, morphine, digoxin and hospitalization, and less frequently nitroglycerin. The low-activity EDs used less NIV, digoxin, and hospitalization, and more IV diuretics.Conclusion. The type of hospital and the volume of activity of the ED are associated with differences in the diagnostic and therapeutic management of AHF in the emergency room.