Editor's Choice– Impact of identifying precipitating factors on 30-day mortality in acute heart failure patients. Issue 7 (October 2019)

• Record Type: Journal Article
• Authors: Rossello, Xavier; Gil, Víctor; Escoda, Rosa; Jacob, Javier; Aguirre, Alfons; Martín-Sánchez, Francisco J; Llorens, Pere; Herrero Puente, Pablo; Rizzi, Miguel; Raposeiras-Roubín, Sergio; Wussler, Desiree; Müller, Christian E; Gayat, Etienne; Mebazaa, Alexandre; Miró, Òscar
• Other Names: Fuentes Marta non-byline-author.; Gil Cristina non-byline-author.; Alonso Héctor non-byline-author.; Pérez-Llantada Enrique non-byline-author.; Martín-Sánchez Francisco Javier non-byline-author.; García Guillermo Llopis non-byline-author.; Cadenas Mar Suárez non-byline-author.; Miró Òscar non-byline-author.; Gil Víctor non-byline-author.; Escoda Rosa non-byline-author.; Xipell Carolina non-byline-author.; Sánchez Carolina non-byline-author.; Pérez-Durá María José non-byline-author.; Salvo Eva non-byline-author.; Pavón José non-byline-author.; Noval Antonio non-byline-author.; Torres José Manuel non-byline-author.; López-Grima María Luisa non-byline-author.; Valero Amparo non-byline-author.; Juan María Ángeles non-byline-author.; Aguirre Alfons non-byline-author.; Pedragosa Maria Àngels non-byline-author.; Masó Silvia Mínguez non-byline-author.; Alonso María Isabel non-byline-author.; Ruiz Francisco non-byline-author.; Franco José Miguel non-byline-author.; Mecina Ana Belén non-byline-author.; Tost Josep non-byline-author.; Berenguer Marta non-byline-author.; Donea Ruxandra non-byline-author.; Ramón Susana Sánchez non-byline-author.; Rodríguez Virginia Carbajosa non-byline-author.; Piñera Pascual non-byline-author.; Nicolás José Andrés Sánchez non-byline-author.; Garate Raquel Torres non-byline-author.; Alquézar-Arbé Aitor non-byline-author.; Rizzi Miguel Alberto non-byline-author.; Herrera Sergio non-byline-author.; Jacob Javier non-byline-author.; Roset Alex non-byline-author.; Cabello Irene non-byline-author.; Haro Antonio non-byline-author.; Richard Fernando non-byline-author.; Pérez José María Álvarez non-byline-author.; Diez María Pilar López non-byline-author.; Puente Pablo Herrero non-byline-author.; Álvarez Joaquín Vázquez non-byline-author.; García Belén Prieto non-byline-author.; García María García non-byline-author.; González Marta Sánchez non-byline-author.; Llorens Pere non-byline-author.; Javaloyes Patricia non-byline-author.; Marquina Víctor non-byline-author.; Jiménez Inmaculada non-byline-author.; Hernández Néstor non-byline-author.; Brouzet Benjamín non-byline-author.; Espinosa Begoña non-byline-author.; Andueza Juan Antonio non-byline-author.; Romero Rodolfo non-byline-author.; Ruíz Martín non-byline-author.; Calvache Roberto non-byline-author.; Serralta María Teresa Lorca non-byline-author.; Jave Luis Ernesto Calderón non-byline-author.; Arriaga Beatriz Amores non-byline-author.; Bergua Beatriz Sierra non-byline-author.; Mojarro Enrique Martín non-byline-author.; Jiménez Brigitte Silvana Alarcón non-byline-author.; Bécquer LisetteTravería non-byline-author.; Burillo Guillermo non-byline-author.; García Lluís Llauger non-byline-author.; LaSalle Gerard Corominas non-byline-author.; Urbano Carmen Agüera non-byline-author.; Soto Ana Belén García non-byline-author.; Padial Elisa Delgado non-byline-author.; Ferrer Ester Soy non-byline-author.; Garrido José Manuel non-byline-author.; Lucas-Imbernón Francisco Javier non-byline-author.; Gaya Rut non-byline-author.; Bibiano Carlos non-byline-author.; Mir María non-byline-author.; Rodríguez Beatriz non-byline-author.; Carballo José Luis non-byline-author.; Rodríguez-Adrada Esther non-byline-author.; Miranda Belén Rodríguez non-byline-author.;
• Is Part Of: European heart journal. Volume 8:Issue 7(2019)
• Page Start: 667
• Page End: 680
• Publication Date: 2019-10
• Subjects: Acute heart failure -- precipitant factors -- mortality -- outcome; 616.1205
• DOI: 10.1177/2048872619869328
• Languages: English
• ISSNs: 2048-8726

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.