Background
Methods
Study design and study setting
Selection of Participants
Methods and measurements
Outcomes
Analysis
Results
Characteristics of study subjects
Age, years (mean, SD) (N = 1,638) | 77.1 (10.7) |
Female (%) (N = 1,638) | 753 (46) |
Arrival status | |
Heart rate, per min (mean, SD) (N = 1,638) | 84.2 (20.1) |
Heart rate < 50 % maximal heart rate (N = 1,638) | 460 (27.6) |
Heart rate = 50-75 % maximal heart rate (N = 1,638) | 958 (58.4) |
Heart rate > 75 % maximal heart rate (N = 1,638) | 220 (13.5) |
Respiratory rate, per min (mean, SD) (N = 1,554) | 22.3 (5.9) |
Systolic blood pressure, mm Hg (mean, SD) (N = 1,638) | 141 (27.6) |
Systolic blood pressure < 120 mm Hg | 377 (23.0) |
Systolic blood pressure = 120-140 mm Hg | 436 (26.6) |
Systolic blood pressure > 140 mm Hg | 825 (50.4) |
Diastolic blood pressure, mm Hg (mean, SD) (N = 558) | 78 (15.8) |
Past medical history (%) | |
Heart Failure (N = 1,638) | 1,194 (73) |
COPD (N = 1,638) | 364 (22) |
Myocardial infarction/angina (N = 1,638) | 674 (41) |
CABG/PCI (N = 1,638) | 539 (33) |
Atrial fibrillation (permanent) (N = 1,638) | 637 (39) |
Hypertension (N = 1,638) | 1,148 (70) |
Current meds (%) | |
ACE inhibitors (N = 1,635) | 717 (44) |
Betablockers (N = 1,638) | 730 (45) |
Calcium channel blockers (N = 1,635) | 543 (33) |
Diuretics (N = 1,638) | 1,221 (75) |
Nitrates (N = 1,635) | 505 (31) |
Beta-agonists (N = 1,634) | 401 (25) |
Laboratory values (mean, SD) | |
Urea, mmol/L (N = 1,567) | 10.7 (7.2) |
Creatinine, mmol/L (N = 1,629) | 122.2 (69.4) |
NT-proBNP Level, ng/L (N = 974) | 8,616.5 (12,175.7) |
Troponin on arrival, 99th percentile = 1 (N = 1,543) | 3 (11.3) |
White blood cells,/microL (N = 1,629) | 9.1 (5.7) |
Hemoglobin, g/L (N = 1,627) | 119.6 (20) |
Findings on Initial ECG (%) | |
Atrial Fibrillation/flutter (N = 1,607) | 599 (37) |
Old Infarction (N = 1,604) | 201 (13) |
CXR findings (%) | |
Pulmonary congestion (N = 1,625) | 1,033 (64) |
Pleural effusion (N = 1,625) | 884 (54) |
Cardiomegaly (N = 1,625) | 924 (57) |
Serious adverse events (%) | 232 (14) |
Patients admitted to hospital (%) | 830 (51) |
Details of serious adverse events (%) | |
Death within 30 days | 40 (4) |
Critical care or other monitored unit (N = 830) | 92 (11) |
Intubation required after admission (N = 830) | 32 (4) |
Myocardial infarction after admission (N = 830) | 32 (4) |
Death after admission (N = 830) | 32 (4) |
Return to emergency department and admitted to hospital (N = 164) | 77 (47) |
Univariate analyses for the association between hemodynamic and pre-specified risk factors
SBP groups | <120 mm Hg | 120 to 140 mm Hg | >140 mm Hg | |||||||
---|---|---|---|---|---|---|---|---|---|---|
HR groups | <50 % HRM | 50 to 75 % HRM | >75 % HRM | <50 % HRM | 50 to 75 % HRM | >75 % HRM | <50 % HRM | 50 to 75 % HRM | >75 % HRM | |
Characteristics | Group 1 (N = 102) | Group 2 (N = 225) | Group 3 (N = 53) | Group 4 (N = 114) | Group 5 (N = 271) | Group 6 (N = 49) | Group 7 (N = 243) | Group 8 (N = 463) | Group 9 (N = 118) |
P-value |
Age, years (mean, SD) | 74.8 (10.3) | 77.6 (10.8) | 83 (8.1) | 75.4 (10.8) | 77 (11) | 82.4 (8.8) | 73.9 (10.1) | 77.3 (10.9) | 80.4 (9.5) | < .001 |
Female (%) | 37 (36) | 94 (42) | 27 (51) | 37 (32) | 132 (49) | 31 (63) | 97 (40) | 236 (51) | 62 (53) | < .001 |
Arrival status | ||||||||||
Arrival by ambulance (%) | 32 (31) | 81 (36) | 18 (34) | 57 (50) | 120 (44) | 26 (53) | 85 (35) | 199 (43) | 61 (52) | .002 |
Temperature, Celsius (mean, SD) | 36 (0.8) | 36.2 (0.8) | 36.2 (0.8) | 36.2 (0.7) | 36.2 (0.7) | 36.3 (0.7) | 36.1 (0.7) | 36.3 (0.8) | 36.2 (0.8) | .366 |
Heart rate, per min (mean, SD) | 63.1 (7.4) | 87.3 (11.5) | 117.2 (13.4) | 61.7 (8.1) | 87.4 (11.8) | 117.7 (14.5) | 62.7 (7.7) | 86.6 (11.8) | 116.7 (14.2) | < .001 |
Respiratory rate, per min (mean, SD) | 20.7 (4.6) | 22.1 (6.7) | 23.1 (5.3) | 21.2 (4.5) | 21.7 (5.2) | 25.5 (8.3) | 21.2 (4.8) | 22.8 (5.8) | 25 (7.1) | < .001 |
Systolic blood pressure, mm Hg (mean, SD) | 108.7 (8.4) | 106.8 (11.1) | 107.5 (13.4) | 130 (5.8) | 128.8 (6) | 131.3 (5.1) | 163.6 (18.9) | 162 (19.8) | 162.7 (20) | < .001 |
Diastolic blood pressure, mm Hg (mean, SD) | 65 (9.2) | 66.9 (11) | 66.4 (14.3) | 69.6 (10.8) | 76.3 (11.3) | 80.2 (10.8) | 77.7 (13.5) | 86.3 (15.7) | 96 (15.7) | < .001 |
SaO2 by oximetry, % (mean, SD) | 95.2 (3.8) | 94.8 (4.5) | 94.2 (5.7) | 94.9 (3.8) | 94.4 (5.5) | 94.1 (5) | 94.9 (3.9) | 94 (5.6) | 93.7 (5.3) | .473 |
Past medical history (%) | ||||||||||
Heart Failure | 82 (80) | 190 (84) | 48 (91) | 92 (81) | 204 (75) | 31 (63) | 154 (63) | 316 (68) | 77 (65) | < .001 |
COPD | 14 (14) | 57 (25) | 16 (30) | 23 (20) | 69 (25) | 14 (29) | 38 (16) | 103 (22) | 30 (25) | .027 |
Intubation for respiratory distress | 1 (1) | 3 (1) | 2 (4) | 2 (2) | 3 (1) | 1 (2) | 1 (0) | 4 (1) | 3 (3) | .534 |
Myocardial infarction/angina | 49 (48) | 95 (42) | 21 (40) | 59 (52) | 110 (41) | 19 (39) | 118 (49) | 163 (35) | 40 (34) | .004 |
CABG/PCI | 45 (44) | 71 (32) | 11 (21) | 57 (50) | 83 (31) | 7 (14) | 107 (44) | 136 (29) | 22 (19) | < .001 |
Pacemaker | 30 (29) | 44 (20) | 5 (9) | 24 (21) | 43 (16) | 4 (8) | 38 (16) | 50 (11) | 7 (6) | < .001 |
Atrial fibrillation (permanent) | 39 (38) | 110 (49) | 33 (62) | 38 (33) | 124 (46) | 28 (57) | 64 (26) | 149 (32) | 52 (44) | < .001 |
Peripheral vascular disease (intervention) | 7 (7) | 10 (4) | 1 (2) | 11 (10) | 13 (5) | 2 (4) | 17 (7) | 24 (5) | 4 (3) | .374 |
Cancer (active) | 5 (5) | 11 (5) | 4 (8) | 6 (5) | 15 (6) | 3 (6) | 10 (4) | 23 (5) | 8 (7) | .98 |
Hypertension | 57 (56) | 129 (57) | 32 (60) | 70 (61) | 180 (66) | 38 (78) | 193 (79) | 362 (78) | 87 (74) | < .001 |
Stroke or TIA | 10 (10) | 31 (14) | 7 (13) | 13 (11) | 46 (17) | 10 (20) | 42 (17) | 65 (14) | 18 (15) | .534 |
Diabetes | 46 (45) | 86 (38) | 15 (28) | 59 (52) | 98 (36) | 13 (27) | 124 (51) | 178 (38) | 36 (31) | < .001 |
Dementia | 2 (2) | 4 (2) | 2 (4) | 3 (3) | 11 (4) | 6 (12) | 6 (2) | 13 (3) | 4 (3) | .032 |
Chronic renal failure | 18 (18) | 56 (25) | 7 (13) | 24 (21) | 45 (17) | 9 (18) | 65 (27) | 93 (20) | 19 (16) | .062 |
Home oxygen | 3 (3) | 28 (12) | 2 (4) | 12 (11) | 22 (8) | 3 (6) | 8 (3) | 22 (5) | 6 (5) | < .001 |
Current meds (%) | ||||||||||
ACE inhibitors | 43 (42) | 103 (46) | 24 (45) | 61 (54) | 112 (41) | 20 (41) | 102 (42) | 202 (44) | 50 (42) | .639 |
Anti-arrhythmics | 14 (14) | 16 (7) | ) 3 (6) | 17 (15) | 21 (8) | 1 (2) | 21 (9) | 24 (5) | 7 (6) | .006 |
Antiplatelet | 55 (54) | 108 (48) | 23 (43) | 64 (56) | 116 (43) | 21 (43) | 142 (58) | 199 (43) | 45 (38) | < .001 |
Anticoagulants | 47 (46) | 100 (44) | 21 (40) | 49 (43) | 105 (39) | 17 (35) | 64 (26) | 162 (35) | 44 (37) | .002 |
Betablockers | 61 (60) | 113 (50) | 21 (40) | 64 (56) | 116 (43) | 16 (33) | 100 (41) | 194 (42) | 45 (38) | < .001 |
Calcium channel blockers | 26 (25) | 62 (28) | 16 (30) | 37 (32) | 90 (33) | 18 (37) | 89 (37) | 176 (38) | 29 (25) | .031 |
Digoxin | 11 (11) | 33 (15) | 12 (23) | 16 (14) | 45 (17) | 5 (10) | 25 (10) | 51 (11) | 18 (15) | .134 |
Diuretics | 87 (85) | 190 (84) | 45 (85) | 90 (79) | 205 (76) | 32 (65) | 172 (71) | 321 (69) | 79 (67) | < .001 |
Nitrates | 36 (35) | 82 (36) | 13 (25) | 45 (39) | 70 (26) | 14 (29) | 80 (33) | 136 (30) | 29 (25) | .051 |
Statins | 77 (75) | 133 (59) | 32 (60) | 73 (64) | 134 (50) | 22 (45) | 165 (68) | 256 (56) | 61 (52) | < .001 |
Vasodilators | 6 (6) | 8 (4) | 0 (0) | 11 (10) | 11 (4) | 2 (4) | 12 (5) | 20 (4) | 6 (5) | .238 |
Antibiotics | 6 (6) | 8 (4) | 5 (10) | 11 (10) | 19 (7) | 5 (10) | 18 (7) | 22 (5) | 6 (5) | .24 |
Inhaled anticholinergics | 13 (13) | 53 (24) | 14 (27) | 18 (16) | 49 (18) | 12 (24) | 22 (9) | 69 (15) | 26 (22) | < .001 |
Beta-agonists | 22 (22) | 65 (29) | 21 (40) | 30 (26) | 76 (28) | 14 (29) | 33 (14) | 112 (24) | 28 (24) | < .001 |
Inhaled steroids | 18 (18) | 50 (22) | 10 (19) | 19 (17) | 55 (20) | 14 (29) | 20 (8) | 87 (19) | 20 (17) | .003 |
Oral steroids | 5 (5) | 13 (6) | 5 (10) | 2 (2) | 9 (3) | 1 (2) | 7 (3) | 16 (3) | 3 (3) | .213 |
Laboratory values (mean, SD) | ||||||||||
Urea, mmol/L | 14.4 (12.1 | 12 (6.5) | 12.9 (7.8) | 12.4 (12.3) | 9.9 (5.6) | 10 (4.9) | 11.1 (6.8) | 9.3 (5.4) | 8.8 (4.1) | < .001 |
Creatinine, mmol/L | 141.2 (66.4) | 124.5 (53.3) | 128.8 (76.9) | 134 (78.7) | 110 (52.5) | 112.6 (50.2) | 139.7 (91.8) | 116.1 (72.2) | 106.9 (48.4) | < .001 |
Serum CO2, mmol/L | 26 (3.8) | 25.7 (4.1) | 25.3 (4.1) | 26.2 (3.7) | 26 (4.2) | 25.1 (4.8) | 25.3 (3.7) | 25.5 (3.9) | 25.1 (3.5) | .096 |
Glucose, mmol/L | 7.6 (3.6) | 7.5 (2.8) | 8.3 (4.8) | 7.2 (3.1) | 7.1 (2.9) | 7.6 (2.6) | 8 (3.4) | 8 (3.7) | 8.9 (4.2) | < .001 |
pCO2, mm Hg | 45.8 (10.3) | 47.4 (13.6) | 46.2 (10.7) | 46.3 (11.6) | 48.2 (11.9) | 45.7 (16.5) | 43.7 (9.3) | 45.2 (11.4) | 46.3 (9.6) | .336 |
pH | 7.4 (0.1) | 7.4 (0.1) | 7.4 (0.1) | 7.4 (0.1) | 7.4 (0.1) | 7.4 (0.1) | 7.4 (0.1) | 7.4 (0.1) | 7.3 (0.1) | .183 |
NT-proBNP Level, ng/L | 8,743.8 (9,243.7) | 9,493 (10,024) | 10,698.8 (9,249.4) | 7,870.4 (10,049.7) | 8,946.1 (14,830.9) | 9,398.7 (8,792.3) | 8,736.1 (17,509.2) | 7,453.4 (8,985.9) | 9,744.2 (13,529.5) | .003 |
Troponin on arrival, 99th percentile = 1 | 4.4 (13.9) | 4.3 (15.9) | 4 (10.9) | 2.2 (5.5) | 2.5 (5.4) | 1.8 (2.2) | 1.8 (4) | 2.6 (8.3) | 5.5 (25.3) | .015 |
White blood cells,/microL | 8.1 (3.2) | 8.8 (6.2) | 10.7 (9.7) | 8.3 (2.5) | 8.3 (2.9) | 9.4 (5.4) | 8.4 (2.7) | 9.9 (8) | 10 (3.8) | < .001 |
Hemoglobin, g/L | 119.8 (19.9) | 117.5 (20.1) | 116.1 (16.7) | 116.9 (18.3) | 119.8 (21.4) | 120.3 (18.8) | 118.9 (18.6) | 120.1 (20.8) | 127 (18.3) | .001 |
Findings on initial ECG (%) | ||||||||||
Atrial Fibrillation/flutter | 28 (28) | 98 (44) | 38 (72) | 31 (28) | 118 (44) | 34 (71) | 54 (23) | 140 (31) | 58 (50) | < .001 |
Acute Ischemia | 0 (0) | 7 (3) | 1 (2) | 2 (2) | 2 (1) | 3 (6) | 6 (3) | 17 (4) | 9 (8) | .008 |
Old Infarction | 20 (20) | 33 (15) | 6 (11) | 12 (11) | 30 (11) | 6 (12) | 25 (11) | 53 (12) | 16 (14) | .365 |
CXR findings (%) | ||||||||||
Pulmonary congestion | 59 (59) | 148 (66) | 34 (64) | 64 (57) | 160 (60) | 27 (55) | 141 (59) | 311 (67) | 89 (76) | .008 |
Pleural effusion | 50 (50) | 126 (57) | 33 (62) | 45 (40) | 150 (56) | 31 (63) | 122 (51) | 251 (54) | 76 (65) | .008 |
Pneumonia | 6 (6) | 18 (8) | 3 (6) | 5 (4) | 15 (6) | 5 (10) | 13 (5) | 33 (7) | 12 (10) | .606 |
Cardiomegaly | 65 (65) | 139 (62) | 29 (55) | 61 (54) | 159 (59) | 30 (61) | 129 (54) | 251 (54) | 61 (52) | .251 |
Multivariate analyses for the association between hemodynamic and patient outcomes
SBP groups | <120 mm Hg | 120 to 140 mm Hg | >140 mm Hg | ||||||
---|---|---|---|---|---|---|---|---|---|
HR groups | <50 % MHR | 50 to 75 % MHR | >75 % MHR | <50 % MHR | 50 to 75 % MHR | >75 % MHR | <50 % MHR | 50 to 75 % MHR | >75 % MHR |
Characteristics | Group 1 (N = 102) | Group 2 (N = 225) | Group 3 (N = 53) | Group 4 (N = 114) | Group 5 (N = 271) | Group 6 (N = 49) | Group 7 (N = 243) | Group 8 (N = 463) | Group 9 (N = 118) |
Serious adverse events (%) | 15 (15)** | 45 (20)*** | 16 (30)*** | 9 (8) | 35(13)** | 12 (24)*** | 14(6) | 61 (13)* | 25(21)*** |
Adjusted OR [95 % CIs] (a) | 3.351 [1.474, 7.620] | 4.313 [2.146, 8.667] | 9.458 [3.838, 23.310] | 1.403 [0.552, 3.568] | 2.950 [1.467, 5.934] | 7.277 [2.762, 19.172] | Reference | 2.373 [1.233, 4.565] | 6.078 [2.769, 13.344] |
Patients admitted to hospital (%) | 43 (42) | 120 (53)* | 34 (64) | 46 (40) | 150 (55)*** | 32 (65) | 93 (38) | 236 (51)* | 76 (64)** |
Adjusted OR [95 % CIs] (a) | 1.387 [0.830, 2.318] | 1.698 [1.118, 2.579] | 1.954 [0.988, 3.865] | 1.170 [0.708, 1.935] | 2.029 [1.373, 2.999] | 2.031 [0.988, 4.172] | Reference | 1.460 [1.032, 2.066] | 2.497 [1.451, 4.296] |
Details of serious adverse events (%) | |||||||||
Death within 30 days | 3 (5) | 8 (5) | 3 (7) | 2 (3) | 8 (4) | 4 (12) | 1 (1) | 8 (2) | 3 (4) |
Critical care or other monitored unit | 9 (21) | 16 (13) | 10 (29) | 1 (2) | 11 (7) | 2 (6) | 5 (5) | 21 (9) | 17 (22) |
Intubation required after admission | 2 (5) | 4 (3) | 1 (3) | 0 (0) | 1 (1) | 0 (0) | 0 (0) | 2 (1) | 2 (3) |
Myocardial infarction after admission | 0 (0) | 3 (2) | 1 (3) | 4 (9) | 3 (2) | 2 (6) | 3 (3) | 8 (3) | 8 (11) |
Death after admission | 1 (2) | 6 (5) | 3 (9) | 0 (0) | 9 (6) | 3 (9) | 0 (0) | 7 (3) | 3 (4) |
Return to emergency department and admitted to hospital | 5 (71) | 20 (53) | 5 (42) | 5 (42) | 9 (39) | 3 (50) | 6 (26) | 20 (56) | 4 (57) |