Association Between Prehospital Time Interval and Short-Term Outcome in Acute Heart Failure Patients MASASHI TAKAHASHI, MD, SHUN KOHSAKA, MD, HIROAKI MIYATA, PhD, TSUTOMU YOSHIKAWA, MD, ATSUTOSHI TAKAGI, MD, KAZUMASA HARADA, MD, TAKAMICHI MIYAMOTO,MD,TETSUO SAKAI, MD, KEN NAGAO, MD, NAOKI SATO, MD, AND MORIMASATAKAYAMA, MD, FOR TOKYO CCU NETWORK COUNCIL Tokyo, Japan ABSTRACT Background: Acute heart failure (AHF) is one of the most frequently encountered cardiovascular condi- tions that can seriously affect the patient’s prognosis. However, the importance of early triage and treat- ment initiation in the setting of AHF has not been recognized. Methods and Results: The Tokyo Cardiac Care Unit Network Database prospectively collected informa- tion of emergency admissions to acute cardiac care facilities in 2005e2007 from 67 participating hospitals in the Tokyo metropolitan area. We analyzed records of 1,218 AHF patients transported to medical centers via emergency medical services (EMS). AHF was defined as rapid onset or change in the signs and symp- toms of heart failure, resulting in the need for urgent therapy. Patients with acute coronary syndrome were excluded from this analysis. Logistic regression analysis was performed to calculate the risk-adjusted in- hospital mortality. A majority of the patients were elderly (76.1 6 11.5 years old) and male (54.1%). The overall in-hospital mortality rate was 6.0%. The median time interval between symptom onset and EMS arrival (response time) was 64 minutes (interquartile range [IQR] 26e205 minutes), and that between EMS arrival and ER arrival (transportation time) was 27 minutes (IQR 9e78 minutes). The risk- adjusted mortality increased with transportation time, but did not correlate with the response time. Those who took O45 minutes to arrive at the medical centers were at a higher risk for in-hospital mortality (odds ratio 2.24, 95% confidence interval 1.17e4.31; P 5 .015). Conclusions: Transportation time correlated with risk-adjusted mortality, and steps should be taken to reduce the EMS transfer time to improve the outcome in AHF patients. (J Cardiac Fail 2011;17:742e747) Key Words: Network, heart failure, ambulance. Acute heart failure (AHF) is one of the most frequently encountered cardiovascular conditions and can seriously af- fect the patient’s prognosis. 1e3 However, there is little addi- tional guidance on how emergency medical services (EMS) should optimize their time before hospital arrival. In the acute settings of other cardiovascular disease, particularly ischemic conditions, reducing the time until initial medical care is important for improving the prognosis. For example, immediate cardiopulmonary resuscitation and defibrillation for ventricular tachycardia/fibrillation contribute to im- proved prognosis in patients with sudden cardiac arrest. 4,5 Timely coronary reperfusion by primary percutaneous cor- onary intervention (PCI) is the cornerstone of modern man- agement in the case of high-risk acute coronary syndrome; both symptom-to-reperfusion and door-to-balloon times are important predictors of ST-segment elevation myocar- dial infarction (STEMI). 6,7 Current guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) recommend that the interval from the first medical contact to PCI be !90 minutes for individuals experiencing STEMI. Early and appropriate intervention to AHF patients may aid in improving the short-term outcome of AHF. The pres- ent study aimed to describe the preehospital system time intervals from symptom onset to Emergency Room (ER) ar- rival to assess the relationship between the time intervals From the Tokyo CCU Network Scientific Committee, Tokyo, Japan. Manuscript received December 17, 2010; revised manuscript received April 17, 2011; revised manuscript accepted May 9, 2011. Reprint requests: Shun Kohsaka, MD, Department of Cardiology, Keio University Hospital, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan. E-mail: sk2798@columbia.edu See page 746 for disclosure information. 1071-9164/$ - see front matter Ó 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.cardfail.2011.05.005 742 Journal of Cardiac Failure Vol. 17 No. 9 2011