The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study
Authors: Harjola Pia , Tarvasmäki Tuukka , Barletta Cinzia , Body Richard , Capsec Jean , Christ Michael , Garcia-Castrillo Luis , Golea Adela , Karamercan Mehmet A. , Martin Paul-Louis , Miró Òscar , Tolonen Jukka , van Meer Oene , Palomäki Ari , Verschuren Franck , Harjola Veli-Pekka , Laribi Said ,   On Behalf of the EURODEM Study Group, Plaisance Patrick , Dandachi Ghanima Al , Maignan Maxime , Pateron Dominique , Hermand Christelle , Tessier Cindy , Roy Pierre-Marie , Bucco Lucie , Duytsche Nicolas , Garmilla Pablo , Carbone Giorgio , Cosentini Roberto , Truță Sorana , Hrihorișan Natalia , Cimpoeșu Diana , Rotaru Luciana , Petrică Alina , Cojocaru Mariana , Nica Silvia , Tudoran Rodica , Vecerdi Cristina , Puticiu Monica , Schönberger Titus , Coolsma Constant , Baggelaar Maarten , Fransen Noortje , van den Brand Crispijn , Idzenga Doutsje , Maas Maaike , Franssen Myriam , Staal Charlotte Mackaij , Schutte Lot , de Kubber Marije , Mignot-Evers Lisette , Penninga-Puister Ursula , Jansen Joyce , Kuijten Jeroen , Bouwhuis Marna , Reuben Adam , Smith Jason , Ramlakhan Shammi , Darwent Melanie , Gagg James , Keating Liza , Bongale Santosh , Hardy Elaine , Keep Jeff , Jarman Heather , Crane Steven , Lawal Olakunle , Hassan Taj , Corfield Alasdair , Reed Matthew , Geier Felicitas , Smolarsky Yvonne , Blaschke Sabine , Kill Clemens , Jerrentrup Andreas , Hohenstein Christian , Rockmann Felix , Brünnler Tanja , Ghuysen Alexandre , Vranckx Marc , Karamercan Mehmet A. , Ergin Mehmet , Dundar Zerrin D. , Altuncu Yusuf A. , Arziman Ibrahim , Avcil Mucahit , Katirci Yavuz , Suurmunne Hanna , Kokkonen Liisa , Valli Juha , Kiljunen Minna , Tolonen Jukka , Kaye Sanna , Mäkelä Mikko , Metsäniitty Juhani , Vaula Eija 
Published: February 2022

Abstract
Background
Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes.

Methods
This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression.

Results
Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p < 0.001), more often female (56.4% vs. 42.1%, p = 0.002) and had more dementia (18.7% vs. 7.2%, p < 0.001). On admission, EMS patients had more often confusion (14.2% vs. 2.1%, p < 0.001) and higher respiratory rate (24/min vs. 21/min, p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027).

Conclusion
Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.