1. Impact of identifying precipitating factors on 30-day mortality in acute heart failure patients
- Author
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Rossello, X, Gil, V, Escoda, R, Jacob, J, Aguirre, A, Martin-Sanchez, FJ, Llorens, P, Puente, PH, Rizzi, M, Raposeiras-Roubin, S, Wussler, D, Muller, CE, Gayat, E, Mebazaa, A, Miro, O, Fuentes, M, Gil, C, Alonso, H, Perez-Llantada, E, Garcia, GL, Cadenas, MS, Xipell, C, Sanchez, C, Perez-Dura, MJ, Salvo, E, Pavon, J, Noval, A, Tones, JM, Lopez-Grima, ML, Valero, A, Juan, MA, Pedragosa, MA, Maso, SM, Alonso, MI, Ruiz, F, Franco, JM, Mecina, AB, Tost, J, Berenguer, M, Donea, R, Ramon, SS, Rodriguez, VC, Pinera, P, Nicolas, JAS, Garate, RT, Alquezar-Arbe, A, Rizzi, MA, Herrera, S, Roset, A, Cabello, I, Haro, A, Richard, F, Perez, JMA, Diez, MPL, Alvarez, JV, Garcia, BP, Garcia, MG, Gonzalez, MS, Javaloyes, P, Marquina, V, Jimenez, I, Hernandez, N, Brouzet, B, Espinosa, B, Andueza, JA, Romero, R, Ruiz, M, Calvache, R, Serralta, MTL, Jave, LEC, Arriaga, BA, Bergua, BS, Mojarro, EM, Jimenez, BSA, Becquer, LT, Burillo, G, Garcia, LL, LaSalle, GC, Urbano, CA, Soto, ABG, Padial, ED, Ferrer, ES, Garrido, JM, Lucas-Imbernon, FJ, Gaya, R, Bibiano, C, Mir, M, Rodriguez, B, Carballo, JL, Rodriguez-Adrada, E, and Miranda, BR
- Subjects
outcome ,Acute heart failure ,precipitant factors ,mortality - Abstract
Background: The aim of this study was to describe the prevalence and prognostic value of the most common triggering factors in acute heart failure. Methods: Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in three time periods between 2011 and 2016. Precipitating factors were classified as: (a) unrecognized; (b) infection; (c) atrial fibrillation; (d) anaemia; (e) hypertension; (f) acute coronary syndrome; (g) non-adherence; and (h) two or more precipitant factors. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and each precipitant factor. The risk of dying was further evaluated by week intervals over the 30-day follow-up to assess the period of higher vulnerability for each precipitant factor. Results: Approximately 69% of our 9999 patients presented with a triggering factor and 1002 died within the first 30 days (10.0%). The most prevalent factors were infection and atrial fibrillation. After adjusting for 11 known predictors, acute coronary syndrome was associated with higher 30-day mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.02-3.42), whereas atrial fibrillation (OR 0.75; 95% CI 0.56-0.94) and hypertension (OR 0.34; 95% CI 0.21-0.55) were significantly associated with better outcomes when compared to patients without precipitant. Patients with infection, anaemia and non-compliance were not at higher risk of dying within 30 days. These findings were consistent across gender and age groups. The 30-day mortality time pattern varied between and within precipitant factors. Conclusions: Precipitant factors in acute heart failure patients are prevalent and have a prognostic value regardless of the patient's gender and age. They can be managed with specific treatments and can sometimes be prevented.
- Published
- 2019