Association of intravenous digoxin use in acute heart failure with rapid atrial fibrillation and short-term mortality according to patient age, renal function, and serum potassium.

OBJECTIVE/BACKGROUND: Intravenous digoxin is still used in emergency departments (EDs) to treat patients with acute heart failure (AHF), especially in those with rapid atrial fibrillation. We investigated whether intravenous digoxin used to treat rapid atrial fibrillation in patients with AHF may influence mortality. METHODS: A secondary analysis of patients included in the Spanish EAHFE (Epidemiology of Acute Heart Failure in Emergency Departments) cohort, which includes patients diagnosed with AHF in 45 Spanish EDs. The relationships between age, estimated glomerular filtration rate, and potassium with 30-day mortality were investigated using restricted cubic spline models adjusted for relevant patient and episode variables. RESULTS: From the 19 947 patients included, we analyzed 2194 patients with AHF and rapid atrial fibrillation that not receiving digoxin at home, divided according to whether they were or were not treated with intravenous digoxin in the ED. The median age of the patients was 82 years (interquartile range=76-87), 61.4% were women and 65.2% had previous episodes of atrial fibrillation. Digoxin and no digoxin groups were formed by 864 (39.4%) and 1330 (60.6%) patients, respectively. There were 191 deaths within the 30-day follow-up period (8.9%), with no differences between patients receiving or not receiving digoxin (8.5 vs. 9.1%, P = 0.636). Although analysis of restricted cubic spline curves showed that death was associated with advanced age, worse renal function, and hypokalemia and hyperkalemia, the use of intravenous digoxin did not interact with any of these relationships (P = 0.156 for age, P = 0.156 for estimated glomerular filtration rate, P = 0.429 for potassium). CONCLUSION: The use of intravenous digoxin in the ED was not associated with significant changes in 30-day mortality, which was confirmed irrespective of patient age or the existence of renal dysfunction or serum potassium disturbances.

Características de los fallecimientos producidos en un servicio de urgencias hospitalario / Characteristics associated with emergency department deaths

Objetivos: Describir las características demográficas y asistenciales de los pacientes que fallecieron en nuestro servicio de urgencias hospitalario y analizar en qué puntos se podría mejorar la atención asistencial a este grupo de pacientes. Método: Estudio descriptivo de los pacientes que fallecieron en el servicio de urgencias entre el 1 de enero y el 31 de diciembre del 2006, excluyendo los pacientes fallecidos en las áreas de pediatría y ginecología. Se recogieron datos demográficos y clínicos, así como el tiempo de permanencia y la ubicación del paciente en el momento del óbito. Resultados: La tasa de mortalidad fue 0,2%. El perfil habitual fue el de un paciente de edad avanzada cuyo fallecimiento era esperado. La causa más frecuente de muerte fue la neoplasia en fase terminal y la mediana de permanencia en urgencias, de 6 horas. Únicamente se realizaron maniobras de reanimación cardiopulmonar en una cuarta parte de los pacientes. La prevalencia de pacientes con deterioro cognitivo fue del 32%.En la mayoría de ocasiones se consideró adecuada la ubicación del paciente en el momento de producirse su fallecimiento. Conclusiones: Dado el porcentaje no despreciable de pacientes afectos de una enfermedad terminal que fallecen en los servicios de urgencias se debería mejorar los circuitos de derivación hacia unidades más específicas. También es conveniente la elaboración de protocolos específicos para este grupo de pacientes (AU)

Objectives: To report clinical and demographic characteristics of patients who died in our hospital emergency department and to assess several aspects of medical care that could be improved. Methods: Descriptive study of patients who died in the Emergency Department between January 1st and December31st, 2006, excluding those patients who expired in the areas of pediatrics and gynecology. Demographic and clinical data, length of stay and location/placement of the patient at the time of death were recorded. Results: Mortality rate was 0.2%. The most common type of patient was an elderly person whose death was expected. The most frequent cause of death was end-stage malignant disease and the median length of stay was 6 hours. Only 25% of patients undergone cardiopulmonary resuscitation maneuvers. Prevalence of cognitive impairment was32%. Patient location at the time of death was considered correct in most cases. Conclusions: Given the significant ratio of patients with a terminal illness who die in the Emergency Departments, to enhance the transfer to more specific areas is mandatory. To design specific protocols for this group of patients is also desirable (AU)