Delay in seeking treatment before emergent heart failure readmission and its association with clinical phenotype
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RESEARCH
Open Access
Delay in seeking treatment before emergent heart failure readmission and its association with clinical phenotype Makoto Takei1,2*, Kazumasa Harada1, Yasuyuki Shiraishi1, Junya Matsuda1, Yoichi Iwasaki1, Yoshiya Yamamoto1, Kenichi Matsushita1, Tetsuro Miyazaki1, Takamichi Miyamoto1, Kiyosi Iida1, Shuzo Tanimoto1, Yuji Nagatomo1, Toru Hosoda1, Shun Kohsaka1, Takeshi Yamamoto1, Ken Nagao1 and Morimasa Takayama1
Abstract Background: Many patients with emergent heart failure (HF) readmission have a delay between symptom onset and hospitalization. The present study aimed to characterize the interval between symptom onset and hospitalization in patients being readmitted for HF and to compare the clinical phenotypes of patients with delay before emergent readmission with those who presented to the hospital earlier. Methods: Data for a total of 2073 consecutive patients was collected from the Tokyo CCU Network database; the patients were divided into delayed (those who sought medical help > 2 days after symptom onset; n = 271) and early groups (remaining patients; n = 1802), and their clinical characteristics and mode of presentation were compared. Results: Age, sex, and laboratory findings including brain natriuretic peptide and serum creatinine levels were not significantly different between the two groups. Patients in the delayed group had greater chronic fluid retention and symptoms not associated with respiratory failure, whereas those in the early group were more likely to have acute respiratory distress, faster heart and respiration rates, and higher systolic blood pressure. Conclusions: More than one in ten patients with HF readmission delay seeking treatment > 2 days after symptom onset. Patients who delayed seeking treatment showed the phenotype of chronic fluid retention, whereas those who presented to the hospital earlier had the phenotype of acute respiratory failure. Keywords: Heart failure, Emergency medical service, Delay in seeking treatment, Phenotype
Background In recent years, repeated emergent hospitalization for patients with acute heart failure (HF) has become a cause for significant medical and economic burden [1–4]. It is well recognized that educating patients about early signs of HF exacerbation and providing them with early medical intervention in ambulant * Correspondence: [email protected] 1 Tokyo CCU Network Scientific Committee, Tokyo, Japan 2 Department of Cardiology, Saiseikai Central Hospital, Mita 1-4-17, Minato-ku, Tokyo 108-0073, Japan
settings are important to prevent emergent rehospitalization [5–8]. However, some patients who need readmission for HF delay asking for medical help after noticing their first symptoms, even though they have been made aware about the symptoms of HF exacerbation [2, 7, 9–14]. In a previous report, Shiraishi et al. [15] suggested that those who sought medical help earlier showed the phenotype of acute vascular failure, characterized by a transient volume shift from the peripheral veins to the pulmonary circulation, and
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