Impact of the time-to-treatment concept on the outcome of acute-heart failure: A pilot study

Background. - An optimal maximum time of 60 minutes has been recommended in recent guide lines for the first evaluation and treatment of patients with acute heart failure (AHF); however, this has not been tested prospectively. Aim. - To analyze the impact of a time-to-treatment (TTT) strategy of < 60 minutes on the in-hospital outcome of patients with AHF. Methods. - During a single 1-month period, we consecutively enrolled all patients hospitalized with AHF in a prospective cohort. In this pilot study, TTT was defined as the time between the first medical contact to the onset of the first medical intervention. The primary outcome was a composite including in-hospital death or worsening AHF. Results. - Of the 74 patients included, 23 (31%) had a TTT of < 60 minutes. Although these patients were more likely to have a more severe episode of AHF, the primary outcome occurred only in patients with a TTT of >= 60 minutes. The primary outcome was significantly associated with a TTT of >= 60 minutes (P=0.036), low systolic blood pressure (P<0.01), rates more than halfway up the lung fields (P=0.02), infectious precipitating factor (P=0.04) and high serum concentrations of B-type natriuretic peptide (P<0.01) and urea (P=0.03). No significant differences were observed in the rate of treatment-induced acute renal insufficiency or in the long-term rates of death or rehospitalization for heart failure according to ITT. Conclusions. - This study suggests that the recently recommended TTT strategy of < 60 minutes in the setting of AHF might be associated with a better prognosis during hospitalization. Further large prospective works are needed to confirm these preliminary results, and to define more precisely which types of AHF could benefit from this strategy. (C) 2018 Elsevier Masson SAS. All rights reserved.