Author + information
- Received April 13, 2017
- Revision received April 17, 2017
- Accepted April 19, 2017
- Published online June 19, 2017.
- Yuya Matsue, MD, PhDa,b,∗ (, )
- Kevin Damman, MD, PhDb,
- Adriaan A. Voors, MD, PhDb,
- Nobuyuki Kagiyama, MDc,
- Tetsuo Yamaguchi, MD, PhDd,
- Shunsuke Kuroda, MDa,
- Takahiro Okumura, MD, PhDe,
- Keisuke Kida, MD, PhDf,
- Atsushi Mizuno, MDg,
- Shogo Oishi, MDh,
- Yasutaka Inuzuka, MD, PhDi,
- Eiichi Akiyama, MDj,
- Ryuichi Matsukawa, MD, PhDk,
- Kota Kato, MD, PhDl,
- Satoshi Suzuki, MD, PhDm,
- Takashi Naruke, MD, PhDn,
- Kenji Yoshioka, MDo,
- Tatsuya Miyoshi, MD, PhDp,
- Yuichi Baba, MDq,
- Masayoshi Yamamoto, MD, PhDr,
- Koji Murai, MDs,
- Kazuo Mizutani, MD, PhDt,
- Kazuki Yoshida, MD, MPH, MSu and
- Takeshi Kitai, MD, PhDv,w
- aDepartment of Cardiology, Kameda Medical Center, Chiba, Japan
- bUniversity of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
- cDepartment of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
- dDepartment of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
- eDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- fDepartment of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
- gDepartment of Cardiology, St. Luke's International Hospital, Tokyo, Japan
- hDepartment of Cardiology, Himeji Cardiovascular Center, Himeji, Japan
- iDepartment of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan
- jDivision of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
- kDivision of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
- lDepartment of Cardiology, Tokyo Medical University, Tokyo, Japan
- mDepartment of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
- nDepartment of Cardio-angiology, Kitasato University School of Medicine, Sagamihara, Japan
- oDepartment of Cardiology, Awa Regional Medical Center, Chiba, Japan
- pDepartment of Cardiology, Ako City Hospital, Ako, Japan
- qDepartment of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
- rCardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- sDepartment of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
- tDepartment of Cardiology, Kobe Century Memorial Hospital, Kobe, Japan
- uDepartments of Epidemiology & Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- vDepartment of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- wDepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Yuya Matsue, Department of Cardiology, Kameda Medical Center, 929, Kamogawa-city, Chiba, Japan.
Background Acute heart failure (AHF) is a life-threatening disease requiring urgent treatment, including a recommendation for immediate initiation of loop diuretics.
Objectives The authors prospectively evaluated the association between time-to-diuretic treatment and clinical outcome.
Methods REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) was a prospective, multicenter, observational cohort study that primarily aimed to assess the association between time to loop diuretic treatment and clinical outcome in patients with AHF admitted through the emergency department (ED). Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection. Patients with a D2F time <60 min were pre-defined as the early treatment group. Primary outcome was all-cause in-hospital mortality.
Results Among 1,291 AHF patients treated with intravenous furosemide within 24 h of ED arrival, the median D2F time was 90 min (IQR: 36 to 186 min), and 481 patients (37.3%) were categorized as the early treatment group. These patients were more likely to arrive by ambulance and had more signs of congestion compared with the nonearly treatment group. In-hospital mortality was significantly lower in the early treatment group (2.3% vs. 6.0% in the nonearly treatment group; p = 0.002). In multivariate analysis, earlier treatment remained significantly associated with lower in-hospital mortality (odds ratio: 0.39; 95% confidence interval: 0.20 to 0.76; p = 0.006).
Conclusions In this prospective multicenter, observational cohort study of patients presenting at the ED for AHF, early treatment with intravenous loop diuretics was associated with lower in-hospital mortality. (Registry focused on very early presentation and treatment in emergency department of acute heart failure syndrome; UMIN000014105)
This study was funded by The Cardiovascular Research Fund, Tokyo, Japan. Dr. Matsue is supported by the Japan Society for the Promotion of Science Overseas Research Fellowships and received an honorarium from Otsuka Pharmaceutical Co. Dr. Yoshida receives tuition support jointly from the Japan Student Services Organization and Harvard T.H. Chan School of Public Health (partially supported by training grants from Pfizer, Takeda, Bayer, and PhRMA). Dr. Voors received consultancy fees and/or research grants from AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Cardio3Biosciences, GlaxoSmithKline, Merck/Merck Sharpe and Dohme, Novartis, Servier, Sphingotec, Stealth, Trevena, and Vifor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 13, 2017.
- Revision received April 17, 2017.
- Accepted April 19, 2017.
- 2017 American College of Cardiology Foundation