Author + information
- Jin Joo Park, MDa,
- Sun-Hwa Kim, PhDa,
- Il-Young Oh, MDa,
- Dong-Ju Choi, MDa,∗ (, )
- Hyun-Ah Park, MDb,
- Hyun-Jai Cho, MDc,
- Hae-Young Lee, MDc,
- Jae-Yeong Cho, MDd,
- Kye Hun Kim, MDd,
- Jung-Woo Son, MDe,
- Byung-Su Yoo, MDe,
- Jaewon Oh, MDf,
- Seok-Min Kang, MDf,
- Sang Hong Baek, MDg,
- Ga Yeon Lee, MDh,
- Jin Oh Choi, MDh,
- Eun-Seok Jeon, MDh,
- Sang Eun Lee, MDi,
- Jae-Joong Kim, MDi,
- Ju-Hee Lee, MDj,
- Myeong-Chan Cho, MDj,
- Se Yong Jang, MDk,
- Shung Chull Chae, MDk and
- Byung-Hee Oh, MDc
- aCardiovascular Center, Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- bDepartment of Family Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
- cDepartment of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- dHeart Research Center of Chonnam National University, Gwangju, Republic of Korea
- eYonsei University Wonju College of Medicine, Wonju, Republic of Korea
- fYonsei University College of Medicine, Seoul, Republic of Korea
- gDepartment of Internal Medicine, the Catholic University of Korea, Seoul, Republic of Korea
- hDepartment of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
- iDivision of Cardiology, Asan Medical Center, Seoul, Republic of Korea
- jChungbuk National University College of Medicine, Cheongju, Republic of Korea
- kKyungpook National University College of Medicine, Daegu, Republic of Korea
- ↵∗Address for correspondence:
Dr. Dong-Ju Choi, Cardiovascular Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, Republic of Korea.
Objectives This study sought to examine the impact of door-to-diuretic (D2D) time on mortality in patients with acute heart failure (AHF) who were presenting to an emergency department (ED).
Background Most patients with AHF present with congestion. Early decongestion with diuretic agents could improve their clinical outcomes.
Methods The Korea Acute Heart Failure registry enrolled 5,625 consecutive patients hospitalized for AHF. For this analysis, the study included patients who received intravenous diuretic agents within 24 h after ED arrival. Early and delayed groups were defined as D2D time ≤60 min and D2D time >60 min, respectively. The primary outcomes were in-hospital death and post-discharge death at 1 month and 1 year on the basis of D2D time.
Results A total of 2,761 patients met the inclusion criteria. The median D2D time was 128 min (interquartile range: 63 to 243 min), and 663 (24%) patients belonged to the early group. The baseline characteristics were similar between the groups. The rate of in-hospital death did not differ between the groups (5.0% vs. 5.1%; p > 0.999), nor did the post-discharge 1-month (4.0% vs. 3.0%; log-rank p = 0.246) and 1-year (20.6% vs. 19.3%; log-rank p = 0.458) mortality rates. Get With the Guidelines-Heart Failure risk score was calculated for each patient. In multivariate analyses with adjustment for Get With the Guidelines-Heart Failure risk score and other significant clinical covariates and propensity-matched analyses, D2D time was not associated with clinical outcomes.
Conclusions The D2D time was not associated with clinical outcomes in a large prospective cohort of patients with AHF who were presenting to an ED. (Registry [Prospective Cohort] for Heart Failure in Korea [KorAHF]; NCT01389843)
This work was supported by Research of Korea Centers for Disease Control and Prevention (grant nos. 2010-E63003-00, 2011-E63002-00, 2012-E63005-00, 2013-E63003-00, 2013-E63003-01, 2013-E63003-02, and 2016-ER6303-00) and by the SNUBH Research Fund (grant nos. 14-2015-029, 16-2017-003). All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 4, 2017.
- Accepted December 28, 2017.
- 2018 The Authors