Early treatment with intravenous furosemide (<60 min from ED arrival) was associated with lower in-hospital mortality compared to nonearly treatment (2.3% vs. 6.0%; OR 0.39, 95% CI 0.20-0.76).
Cohort (n=1,291)
Yes
Does early treatment with intravenous furosemide (<60 minutes) reduce in-hospital mortality in patients hospitalized with acute heart failure?
Early administration of intravenous loop diuretics (within 60 minutes of ED arrival) is associated with significantly lower in-hospital mortality in patients with acute heart failure.
Odds Ratio: 0.39 (95% CI 0.2–0.76)
Absolute Event Rate: 2.3% vs 6%
p-value: p=0.006
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).
“Taking a little more time doesn't necessarily mean you're putting the patient in harm's way.”
Matsue et al. (Thu,) conducted a cohort in Acute heart failure (n=1,291). Early treatment with intravenous furosemide (door-to-furosemide time <60 min) vs. Nonearly treatment (door-to-furosemide time ≥60 min) was evaluated on all-cause in-hospital mortality (OR 0.39, 95% CI 0.20 to 0.76, p=0.006). Early treatment with intravenous furosemide (<60 min from ED arrival) was associated with lower in-hospital mortality compared to nonearly treatment (2.3% vs. 6.0%; OR 0.39, 95% CI 0.20-0.76).