Atención prehospitalaria a los pacientes con insuficiencia cardiaca aguda en España: estudio SEMICA

espanolObjetivo. Investigar, en los pacientes diagnosticados de insuficiencia cardiaca aguda (ICA) en servicios de urgencias hospitalarios (SUH), su forma de llegada, los factores asociados al tipo de transporte usado y el tratamiento prehospitalario administrado. Metodo. En pacientes diagnosticados consecutivamente de ICA en 34 SUH espanoles se recogio: forma de llegada (transporte sanitario medicalizado –TSM–, no medicalizado –TSNM– o propio –TP–) y tratamiento prehospitalario administrado. Se estudiaron 27 variables independientes potencialmente relacionadas con el tipo de transporte utilizado. Como indicadores de gravedad se registraron nivel de triaje en urgencias, necesidad de ingreso y de cuidados intensivos, mortalidad intrahospitalaria y a 30 dias. Resultados. Se incluyeron 6.106 pacientes [edad: 80 anos (DE:10), 56,5% mujeres]; 47,2% llegaron en TP, 37,8% en TSNM y 15,0% en TSM. El uso de transporte sanitario se asocio a ser mujer, edad > 80 anos, enfermedad pulmonar obstructiva cronica, antecedentes de ICA, dependencia funcional, NYHA III-IV, incontinencia esfinteres y presentar disnea, ortopnea, piel fria y depresion del sensorio/inquietud. La asignacion de TSM se asocio directamente a vivir solo, antecedente de cardiopatia isquemica, presentar piel fria, depresion del sensorio o inquietud y temperatura elevada e inversamente al antecedente de caidas. Los traslados en TP, TSNM y TSM registraron porcentajes crecientes de tratamiento prehospitalario, y su gravedad tambien fue progresivamente creciente. El 73% de pacientes trasladados con TSM recibio oxigeno, el 29% diuretico, el 13,5% vasodilatador y el 4,7% ventilacion no invasiva. Conclusiones. Existen caracteristicas del paciente con ICA relacionadas con el tipo de recurso asignado para su traslado al SUH, y dicha asignacion parece corresponderse con la gravedad del episodio. El tratamiento durante el TSM podria incrementarse. EnglishObjectives. To study the means of emergency transport used to bring patients with acute heart failure (AHF) to hospital emergency departments (EDs) and explore associations between factors, type of transport, and prehospital care received. Methods. We gathered the following information on patients treated for AHF at 34 Spanish hospital EDs: means of transport used (medicalized ambulance [MA], nonmedicalized ambulance [NMA], or private vehicle) and treatments administered before arrival at the hospital. Twenty-seven independent variables potentially related to type of transport used were also studied. Indicators of AHF severity were triage level assigned in the ED, need for admission, need for intensive care, in-hospital mortality, and 30-day mortality. Results. A total of 6106 patients with a mean (SD) age of 80 years were included; 56.5% were women, 47.2% arrived in PVs, 37.8% in NMAs, and 15.0% in MAs. Use of an ambulance was associated with female sex, age over 80 years, chronic obstructive pulmonary disease, a history of AHF, functional dependency, New York Heart Association class III-IV, sphincteral incontinence, labored breathing, orthopnea, cold skin, and sensory depression or restlessness. Assignment of a MA was directly associated with living alone, a history of ischemic heart disease, cold skin, sensory depression or restlessness, and high temperature; it was inversely associated with a history of falls. The rates of receipt of prehospital treatments and AHF severity level increased with use of MAs vs. NMAs vs. PV. Seventy-three percent of patients transported in MAs received oxygen, 29% received a diuretic, 13.5% a vasodilator, and 4.7% noninvasive ventilation. Conclusions. Characteristics of the patient with AHF are associated with the assignment of type of transport to a hospital ED. Assignment appears to be related to severity. Treatment given during MA transport could be increased.