Editor's Choice– Impact of identifying precipitating factors on 30-day mortality in acute heart failure patients. Issue 7 (1st 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; Fuentes, Marta; Gil, Cristina; Alonso, Héctor; Pérez-Llantada, Enrique; Martín-Sánchez, Francisco Javier; García, Guillermo Llopis; Cadenas, Mar Suárez; Miró, Òscar; Gil, Víctor; Escoda, Rosa; Xipell, Carolina; Sánchez, Carolina; Pérez-Durá, María José; Salvo, Eva; Pavón, José; Noval, Antonio; Torres, José Manuel; López-Grima, María Luisa; Valero, Amparo; Juan, María Ángeles; Aguirre, Alfons; Pedragosa, Maria Àngels; Masó, Silvia Mínguez; Alonso, María Isabel; Ruiz, Francisco; Franco, José Miguel; Mecina, Ana Belén; Tost, Josep; Berenguer, Marta; Donea, Ruxandra; Ramón, Susana Sánchez; Rodríguez, Virginia Carbajosa; Piñera, Pascual; Nicolás, José Andrés Sánchez; Garate, Raquel Torres; Alquézar-Arbé, Aitor; Rizzi, Miguel Alberto; Herrera, Sergio; Jacob, Javier; Roset, Alex; Cabello, Irene; Haro, Antonio; Richard, Fernando; Pérez, José María Álvarez; Diez, María Pilar López; Puente, Pablo Herrero; Álvarez, Joaquín Vázquez; García, Belén Prieto; García, María García; González, Marta Sánchez; Llorens, Pere; Javaloyes, Patricia; Marquina, Víctor; Jiménez, Inmaculada; Hernández, Néstor; Brouzet, Benjamín; Espinosa, Begoña; Andueza, Juan Antonio; Romero, Rodolfo; Ruíz, Martín; Calvache, Roberto; Serralta, María Teresa Lorca; Jave, Luis Ernesto Calderón; Arriaga, Beatriz Amores; Bergua, Beatriz Sierra; Mojarro, Enrique Martín; Jiménez, Brigitte Silvana Alarcón; Bécquer, LisetteTravería; Burillo, Guillermo; García, Lluís Llauger; LaSalle, Gerard Corominas; Urbano, Carmen Agüera; Soto, Ana Belén García; Padial, Elisa Delgado; Ferrer, Ester Soy; Garrido, José Manuel; Lucas-Imbernón, Francisco Javier; Gaya, Rut; Bibiano, Carlos; Mir, María; Rodríguez, Beatriz; Carballo, José Luis; Rodríguez-Adrada, Esther; Miranda, Belén Rodríguez;
• Is Part Of: European heart journal. Volume 8:Issue 7(2019)
• Page Start: 667
• Page End: 680
• Publication Date: 2019-10-01
• Subjects: Acute heart failure -- precipitant factors -- mortality -- outcome; 616.1205
• DOI: 10.1177/2048872619869328
• Languages: English
• ISSNs: 2048-8726

Abstract

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.