Table 1.
Patient characteristics among patients visiting an emergency department for acute heart failure, stratified by ejection fraction type: HFrEF (ejection fraction <50%) and HFpEF (ejection fraction ≥50%)
| Characteristic | HFrEF | HFpEF | P value |
|---|---|---|---|
| N | 4843 | 10 432 | |
| Age, median (IQR) | 74.0 (64.0–83.0) | 77.0 (68.0–85.0) | <0.001 |
| Women (%) | 36.3 | 55.7 | <0.001 |
| Race—white/European (%) | 58.7 | 61.4 | 0.0017 |
| Neighbourhood SES, low (%) | 24.3 | 21.8 | 0.0006 |
| Median healthcare utilization in past 365 days, median (IQR) | |||
| ED visits | 1.0 (0.0–3.0) | 1.0 (0.0–3.0) | <0.001 |
| Hospital admissions | 0.0 (0.0–1.0) | 0.0 (0.0–1.0) | <0.001 |
| Outpatient primary care visits | 5.0 (2.0–10.0) | 6.0 (3.0–11.0) | <0.001 |
| Cardiovascular history (%) | |||
| Coronary heart disease | 47.1 | 33.9 | <0.001 |
| Hypertension | 79.7 | 86.4 | <0.001 |
| Myocardial infarction | 29.9 | 19.0 | <0.001 |
| Angina | 11.7 | 9.6 | <0.001 |
| CABG/PCI | 55.3 | 52.7 | 0.0029 |
| Pacemaker | 1.6 | 0.9 | 0.0002 |
| Atrial fibrillation/flutter | 43.7 | 46.9 | 0.0003 |
| HFrEF < 50% | 100.0 | 0.0 | <0.001 |
| Medical history (%) | |||
| ESRD | 8.0 | 10.7 | <0.001 |
| Chronic kidney disease | 48.1 | 51.6 | <0.001 |
| COPD | 15.5 | 19.4 | <0.001 |
| Peripheral vascular disease | 42.5 | 50.4 | <0.001 |
| Active cancer | 9.2 | 11.7 | <0.001 |
| Diabetes | 47.7 | 48.9 | 0.19 |
| Dementia | 3.8 | 4.6 | <0.001 |
| Oxygen dependent a | 0.8 | 1.6 | <0.001 |
| Medications (in past 30 days) (%) | |||
| ACEI or ARB | 54.3 | 45.4 | <0.001 |
| Beta‐blocker | 69.7 | 65.6 | <0.001 |
| Calcium channel blocker | 18.3 | 38.9 | <0.001 |
| Nitrate | 20.0 | 13.0 | <0.001 |
| Arrived by EMS (%) | 30.3 | 33.8 | <0.001 |
| ED triage vital signs, median (IQR) | |||
| Systolic blood pressure (mmHg) | 134.0 (117.0–153.0) | 142.0 (125.0–161.0) | <0.001 |
| Diastolic blood pressure (mmHg) | 79.0 (66.0–93.0) | 74.0 (63.0–88.0) | <0.001 |
| Respiratory rate (per minute) | 20.0 (18.0–24.0) | 20.0 (18.0–24.0) | <0.001 |
| Heart rate (per minute) | 91.0 (76.0–110.0) | 86.0 (72.0–104.0) | <0.001 |
| Oxygen saturation (%) | 97.0 (94.0–98.0) | 95.0 (92.0–98.0) | <0.001 |
| Change in weight over baseline b (%) | |||
| >5 lb above baseline | 19.1 | 23.4 | <0.001 |
| >10 lb above baseline | 10.1 | 13.1 | <0.001 |
| ED laboratory data, median (IQR) | |||
| BNP (pg/mL) | 942 (520–1702) | 480 (239–870) | <0.001 |
| Troponin (pg/mL) | 0.04 (0.03–0.10) | 0.03 (0.02–0.06) | <0.001 |
| Sodium (mmol/L) | 138 (135–140) | 138 (135–140) | 0.0028 |
| BUN (mg/dL) | 25.0 (18.0–37.0) | 24.0 (17.0–37.0) | <0.001 |
| Creatinine (mg/dL) | 1.21 (0.94–1.73) | 1.15 (0.85–1.71) | <0.001 |
| Haemoglobin (g/dL) | 12.3 (10.6–13.7) | 11.4 (9.9–12.9) | <0.001 |
| Chest X‐ray findings (%) | |||
| Cardiomegaly | 48.2 | 42.6 | <0.001 |
| Congestion | 64.7 | 66.2 | 0.079 |
| Pleural effusion | 48.5 | 48.0 | 0.56 |
| Acute illness severity scores, median (IQR) | |||
| COPS2 c score | 67 (35–106) | 75 (43–113) | <0.001 |
| Non‐invasive ventilation used in ED (%) | 13.0 | 13.7 | 0.25 |
| ED disposition (%) | |||
| Discharged | 17.0 | 20.4 | <0.001 |
| Observed | 17.4 | 18.6 | 0.077 |
| Admitted | 65.6 | 61.0 | <0.001 |
| Follow‐up outpatient visit (clinic or telephone) within 7 days of ED visit (%) d | 58.8 | 54.6 | <0.001 |
ACEI, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; BNP, B‐type natriuretic peptide; BUN, blood urea nitrogen; CABG, coronary artery bypass graft; COPD, chronic obstructive pulmonary disease; ED, emergency department; EMS, emergency medical services; ESRD, end‐stage renal disease; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; IQR, inter‐quartile range; PCI, percutaneous coronary intervention; SES, socio‐economic status.
There are a small number of patients who died in the ED, so the sum of discharged, observed, and admitted patients appears smaller than the total study population. Overall, rates of missingness of variables were <5%, except for BNP (10.8% missing) and troponin (11.6% missing).
Oxygen dependent defined as requiring O2 to maintain saturation >92%.
Baseline weight was calculated as the average of all weights from all visits over the previous 365 days.
COPS2—internally derived and validated co‐morbidity risk score (Comorbidity Point Score). 26
We did not adjust for 7 day outpatient follow‐up in the analysis of outcomes.