[Hospital outcome and short-term follow-up of elderly patients presenting to the emergency unit with congestive heart failure]. / Evolução intra-hospitalar e seguimento pós-alta de pacientes idosos atendidos com insuficiência cardíaca congestiva na unidade de emergência.

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 (1 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 occurred. 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 135 mEq/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.

Evoluçäo intra-hospitalar e seguimento pós-alta de pacientes idosos atendidos com insuficiência cardíaca congestiva na unidade de emergência / Hospital outcome and short-term follow-up of predominatly elderly patients presenting to the emergency department with congestive heart failure

OBJETIVO - Conhecer a evoluçäo intra-hospitalar (IH) e pós-alta (PA) de uma populaçäo predominantemente idosa, com insuficiência cardíaca congestiva (ICC) na unidade de emergência (UE). MÉTODOS - Durante 11 meses, foram selecionados 57 pacientes consecutivos com ICC, atendidos em UE, com idade média de 69ñ15 (27 a 94) anos, sendo 39 (68,4 por cento) homens. O diagnóstico de ICC baseou-se nos critérios de Boston. Avaliou-se a evoluçäo IH e PA num período médio de 5,7ñ2,7 (1 A 12) meses, procurando-se identificar variáveis que se correlacionassem com a mortalidade e o mecanismo de morte, avaliado pelo sistema ACME. RESULTADOS - Oito (14 por cento) pacientes faleceram na fase IH, sendo 7 por falência circulatória (FC), e 1 em pós-operatório (PO). Durante o seguimento ocorreram 9 (18,4 por cento) óbitos, sendo 5 por FC, 2 mortes súbitas e 2 em (troca valvar mitral e ventriculectomia). A sobrevida dos pacientes...