Impact of identifying precipitating factors on 30-day mortality in acute heart failure patients
Por:
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, Martin-Sanchez, FJ, 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, Miranda, BR
Publicada:
1 oct 2019
Ahead of Print:
1 ago 2019
Resumen:
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.
Filiaciones:
Rossello, X:
CNIC, Translat Lab Cardiovasc Imaging & Therapy, Madrid, Spain
Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain
Gil, V:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Escoda, R:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain
Hosp Clin Barcelona, Barcelona, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Spain
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Aguirre, A:
Hosp Mar, Emergency Dept, Barcelona, Spain
Hosp Mar Barcelona, Barcelona, Spain
Martin-Sanchez, FJ:
CNIC, Translat Lab Cardiovasc Imaging & Therapy, Madrid, Spain
Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Llorens, P:
Hosp Gen Alicante, Emergency Dept, Alicante, Spain
Hosp Gen Alicante, Alicante, Spain
Puente, PH:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Asturias, Spain
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Rizzi, M:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Raposeiras-Roubin, S:
Univ Hosp Alvaro Cunqueiro, Dept Cardiol, Vigo, Spain
Wussler, D:
Univ Hosp Basel, CRIB, Dept Cardiol, Basel, Switzerland
Muller, CE:
Univ Hosp Basel, CRIB, Dept Cardiol, Basel, Switzerland
GREAT Global REs Acute Cardiovasc Condit Team Net, Rome, Italy
Gayat, E:
St Louis Lariboisiere Univ Hosp, Dept Anesthesiol & Crit Care Med, St Louis, France
Mebazaa, A:
GREAT Global REs Acute Cardiovasc Condit Team Net, Rome, Italy
St Louis Lariboisiere Univ Hosp, Dept Anesthesiol & Crit Care Med, St Louis, France
Miro, O:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain
GREAT Global REs Acute Cardiovasc Condit Team Net, Rome, Italy
Hosp Clin Barcelona, Barcelona, Spain
Fuentes, M:
Hosp Univ Salamanca, Salamanca, Spain
Gil, C:
Hosp Univ Salamanca, Salamanca, Spain
Alonso, H:
Hosp Marques de Valdecilla Santander, Santander, Spain
Perez-Llantada, E:
Hosp Marques de Valdecilla Santander, Santander, Spain
Martin-Sanchez, FJ:
Hosp Clin San Carlos Madrid, Madrid, Spain
Garcia, GL:
Hosp Clin San Carlos Madrid, Madrid, Spain
Cadenas, MS:
Hosp Clin San Carlos Madrid, Madrid, Spain
Xipell, C:
Hosp Clin Barcelona, Barcelona, Spain
Sanchez, C:
Hosp Clin Barcelona, Barcelona, Spain
Perez-Dura, MJ:
Hosp Politen La Fe Valencia, Valencia, Spain
Salvo, E:
Hosp Politen La Fe Valencia, Valencia, Spain
Pavon, J:
Hosp Dr Negrin Las Palmas de Gran Canaria, Las Palmas Gran Canaria, Spain
Noval, A:
Hosp Insular Las Palmas de Gran Canaria, Las Palmas Gran Canaria, Spain
Tones, JM:
Hosp Reina Sofia Cordoba, Cordoba, Spain
Lopez-Grima, ML:
Hosp Dr Peset Valencia, Valencia, Spain
Valero, A:
Hosp Dr Peset Valencia, Valencia, Spain
Juan, MA:
Hosp Dr Peset Valencia, Valencia, Spain
Pedragosa, MA:
Hosp Mar Barcelona, Barcelona, Spain
Maso, SM:
Hosp Mar Barcelona, Barcelona, Spain
Alonso, MI:
Hosp Valme Sevilla, Seville, Spain
Ruiz, F:
Hosp Valme Sevilla, Seville, Spain
Franco, JM:
Hosp Miguel Servet Zaragoza, Zaragoza, Spain
Mecina, AB:
Hosp Alcorcon Madrid, Madrid, Spain
Tost, J:
ConsorciSanitari Terrassa, Terrassa, Barcelona, Spain
Berenguer, M:
ConsorciSanitari Terrassa, Terrassa, Barcelona, Spain
Donea, R:
ConsorciSanitari Terrassa, Terrassa, Barcelona, Spain
Ramon, SS:
Hosp Univ Rio Hortega Valladolid, Valladolid, Spain
Rodriguez, VC:
Hosp Univ Rio Hortega Valladolid, Valladolid, Spain
Pinera, P:
Hosp Reina Sofia Murcia, Murcia, Spain
Nicolas, JAS:
Hosp Reina Sofia Murcia, Murcia, Spain
Garate, RT:
Hosp Severo Ochoa Madrid, Madrid, Spain
Alquezar-Arbe, A:
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Rizzi, MA:
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Herrera, S:
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Roset, A:
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Cabello, I:
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Haro, A:
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Richard, F:
Hosp Univ Burgos, Burgos, Spain
Perez, JMA:
Hosp Univ Burgos, Burgos, Spain
Diez, MPL:
Hosp Univ Burgos, Burgos, Spain
Alvarez, JV:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Garcia, BP:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Garcia, MG:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Gonzalez, MS:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Javaloyes, P:
Hosp Gen Alicante, Alicante, Spain
Marquina, V:
Hosp Gen Alicante, Alicante, Spain
Jimenez, I:
Hosp Gen Alicante, Alicante, Spain
Hernandez, N:
Hosp Gen Alicante, Alicante, Spain
Brouzet, B:
Hosp Gen Alicante, Alicante, Spain
Espinosa, B:
Hosp Gen Alicante, Alicante, Spain
Andueza, JA:
Hosp Gen Univ Gregorio Maranon Madrid, Madrid, Spain
Romero, R:
Hosp Univ Getafe Madrid, Madrid, Spain
Ruiz, M:
Hosp Henares Madrid, Madrid, Spain
Calvache, R:
Hosp Henares Madrid, Madrid, Spain
Serralta, MTL:
Hosp Tajo Madrid, Madrid, Spain
Jave, LEC:
Hosp Tajo Madrid, Madrid, Spain
Arriaga, BA:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Bergua, BS:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Mojarro, EM:
Hosp St Pau & Santa Tecla Tarragona, Tarragona, Spain
Jimenez, BSA:
Hosp St Pau & Santa Tecla Tarragona, Tarragona, Spain
Becquer, LT:
Hosp Univ Canarias Tenerife, Tenerife, Spain
Burillo, G:
Hosp Univ Canarias Tenerife, Tenerife, Spain
Garcia, LL:
Hosp Univ Vic Barcelona, Barcelona, Spain
LaSalle, GC:
Hosp Univ Vic Barcelona, Barcelona, Spain
Urbano, CA:
Hosp Costa del Sol Marbella Malaga, Malaga, Spain
Soto, ABG:
Hosp Costa del Sol Marbella Malaga, Malaga, Spain
Padial, ED:
Hosp Costa del Sol Marbella Malaga, Malaga, Spain
Ferrer, ES:
Hosp Josep Trueta Girona, Girona, Spain
Garrido, JM:
Hosp Virgen Macarena Sevilla, Seville, Spain
Lucas-Imbernon, FJ:
Hosp Gen Univ Albacete, Albacete, Spain
Gaya, R:
Hosp Juan XXIII Tarragona, Tarragona, Spain
Bibiano, C:
Hosp Infanta Leonor Madrid, Madrid, Spain
Mir, M:
Hosp Infanta Leonor Madrid, Madrid, Spain
Rodriguez, B:
Hosp Infanta Leonor Madrid, Madrid, Spain
Carballo, JL:
Complejo Hosp Univ Ourense, Orense, Spain
Rodriguez-Adrada, E:
Hosp Rey Juan Carlos Mostoles Madrid, Madrid, Spain
Miranda, BR:
Hosp Rey Juan Carlos Mostoles Madrid, Madrid, Spain
Bronze, Green Accepted
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