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The FAST-FURO study: effect of very early administration of intravenous furosemide in the prehospital setting to patients with acute heart failure attending the emergency department

2021; Oxford University Press; Volume: 10; Issue: 5 Linguagem: Inglês

10.1093/ehjacc/zuaa042

2048-8734

Òscar Miró, P.‐T. Harjola, Xavier Rosselló, Víctor Gil, Javier Jacob, Pere Llorens, Francisco Javier Martín‐Sánchez, Pablo Herrero, Gemma Martínez‐Nadal, Sira Aguiló, María Luisa López‐Grima, Marta Fuentes, José María Álvarez Pérez, Esther Rodríguez‐Adrada, María Mir, Josep Tost, Lluís Llauger, Frank Ruschitzka, Veli‐Pekka Harjola, Wilfried Müllens, Josep Masip, Ovidiu Chioncel, W. Frank Peacock, Christian Müller, Alexandre Mebazaa, Marta Fuentes, Cristina Gil, Héctor Alonso, Enrique Pérez‐Llantada, Francisco Javier Martín‐Sánchez, Guillermo García, Mar Suárez Cadenas, Òscar Miró, Víctor Gil, Rosa Escoda, Sira Aguiló, Carolina Sánchez, María José Pérez‐Durá, Eva Salvo, José Pavón, Antonio Noval, José Manuel Torres, María Luisa López‐Grima, Amparo Valero, María Ángeles Juan, Alfons Aguirre, María Àngels Pedragosa, Silvia Mínguez Masó, María Isabel Alonso, Francisco Ruiz, José Miguel Franco, Ana Belén Mecina, Josep Tost, Marta Berenguer, Ruxandra Donea, Susana Sánchez Ramón, Virginia Carbajosa Rodríguez, Pascual Piñera, José Andrés Sánchez Nicolás, Raquel Torres Gárate, Aitor Alquézar‐Arbé, Miguel Alberto Rizzi, Sergio Herrera, Javier Jacob, Àlex Roset, Irene Cabello, Antonio Haro, Fernando Richard, José María Álvarez Pérez, María Pilar López Díez, Pablo Herrero, Joaquín Vázquez Álvarez, Belén Prieto García, María García García, Marta Sánchez González, Pere Llorens, Patricia Javaloyes, Víctor Marquina, Inmaculada Mora-Jiménez, Néstor Hernández, Benjamín Brouzet, Begoña Espinosa, Adriana Gil, Juan Antonio Andueza, Rodolfo Romero, Martín Ruíz, Roberto Calvache, María Teresa Lorca Serralta, Luis Ernesto Calderón Jave, Beatriz Amores Arriaga, Beatriz Sierra Bergua, Enrique Martín Mojarro, Brigitte Silvana Alarcón Jiménez, Lisette Travería Bécquer, Guillermo Burillo, Lluís Llauger García, Gerard Corominas LaSalle, Carmen Agüera Urbano, Ana Belén García Soto, Elisa Delgado Padial, Ester Soy Ferrer, María Adrover Múñoz, José Manuel Garrido, Francisco Javier Lucas-Imbernón, Rut Gaya, Carlos Bibiano, María Mir, Beatriz L. Rodríguez, José Luís Carballo, Esther Rodríguez‐Adrada, Belén Rodríguez Miranda, Monika Vicente Martín, Pere Coma Casanova, Joan Espinach Alvarós,

Cardiac Arrest and Resuscitation

The effect of early administration of intravenous (IV) furosemide in the emergency department (ED) on short-term outcomes of acute heart failure (AHF) patients remains controversial, with one recent Japanese study reporting a decrease of in-hospital mortality and one Korean study reporting a lack of clinical benefit. Both studies excluded patients receiving prehospital IV furosemide and only included patients requiring hospitalization. To assess the impact on short-term outcomes of early IV furosemide administration by emergency medical services (EMS) before patient arrival to the ED.In a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry of consecutive AHF patients admitted to Spanish EDs, patients treated with IV furosemide at the ED were classified according to whether they received IV furosemide from the EMS (FAST-FURO group) or not (CONTROL group). In-hospital all-cause mortality, 30-day all-cause mortality, and prolonged hospitalization (>10 days) were assessed. We included 12 595 patients (FAST-FURO = 683; CONTROL = 11 912): 968 died during index hospitalization [7.7%; FAST-FURO = 10.3% vs. CONTROL = 7.5%; odds ratio (OR) = 1.403, 95% confidence interval (95% CI) = 1.085-1.813; P = 0.009], 1269 died during the first 30 days (10.2%; FAST-FURO = 13.4% vs. CONTROL = 9.9%; OR = 1.403, 95% CI = 1.146-1.764; P = 0.004), and 2844 had prolonged hospitalization (22.8%; FAST-FURO = 25.8% vs. CONTROL = 22.6%; OR = 1.189, 95% CI = 0.995-1.419; P = 0.056). FAST-FURO group patients had more diabetes mellitus, ischaemic cardiomyopathy, peripheral artery disease, left ventricular systolic dysfunction, and severe decompensations, and had a better New York Heart Association class and had less atrial fibrillation. After adjusting for these significant differences, early IV furosemide resulted in no impact on short-term outcomes: OR = 1.080 (95% CI = 0.817-1.427) for in-hospital mortality, OR = 1.086 (95% CI = 0.845-1.396) for 30-day mortality, and OR = 1.095 (95% CI = 0.915-1.312) for prolonged hospitalization. Several sensitivity analyses, including analysis of 599 pairs of patients matched by propensity score, showed consistent findings.Early IV furosemide during the prehospital phase was administered to the sickest patients, was not associated with changes in short-term mortality or length of hospitalization after adjustment for several confounders.