Predictors of 30-day mortality in patients admitted to ED for acute heart failure

Objectives

Acute heart failure (AHF) is a leading cause of admission in emergency departments (ED). It is associated with significant in-hospital mortality, suggesting that there is room for improvement of care. Our aims were to investigate clinical patterns, biological characteristics and determinants of 30-day mortality.

Methods

We conducted a single site, retrospective review of adult patients (≥ 18 years) admitted to ED for AHF over a 12-month period. Data collected included demographics, clinical, biological and outcomes data. Epidemiologic data were collected at baseline, and patients were followed up during a 30-day period.

Results

There were a total of 322 patients. Mean age was 83.9 ± 9.1 years, and 47% of the patients were men. Among them, 59 patients (18.3%) died within 30 days of admission to the ED. The following three characteristics were associated with increased mortality: age > 85 years (OR = 1.595%CI:0.8–2.7], p = 0.01), creatinine clearance < 30 mL/min (OR = 2.695%CI:1.4–5], p < 0.001) and Nt-proBNP > 5000 pg/mL (OR = 2.295%CI:1.2–4], p < 0.001). The best Nt-proBNP cut-off value to predict first-day mortality was 9000 pg/mL (area under the curve (AUC) 95%CI] of 0.790 0.634–0.935], p < 0.001). For 7-day mortality, it was 7900 pg/mL (0.698 0.578–0.819], p < 0.001) and for 30-day mortality, 5000 pg/mL (0.667 0.576–0.758], p < 0.001).

Conclusions

Nt-proBNP level on admission, age and creatinine clearance, are predictive of 30-day mortality in adult patients admitted to ED for AHF.