Time-pattern of adverse outcomes after an infection-triggered acute heart failure decompensation and the influence of early antibiotic administration and hospitalisation: results of the PAPRICA-3 study
Por:
Miró Ò, Takagi K, Gayat É, Gil V, Llorens P, Martín-Sánchez FJ, Jacob J, Herrero-Puente P, Escoda R, Pilar López-Díez M, Valero, A, Fuentes M, Garrido JM, Salvo E, Rizzi MA, Aguirre A, Travería Bécquer L, Domínguez-Rodríguez A, Padrosa J, Martínez G, Arrigo M, Freund Y and Mebazaa A
Publicada:
1 ene 2020
Ahead of Print:
29 abr 2019
Resumen:
Objective To investigate whether patients with an acute heart failure (AHF) episode triggered by infection present different outcomes compared to patients with no trigger and the effects of early antibiotic administration (EAA) and hospitalisation. Methods Two groups were made according to the AHF trigger: infection (G1) or none identified (G2). The primary outcome was 13-week (91-days) all-cause mortality, and secondary outcomes were 13-week post-discharge mortality, readmission or combined endpoint. Comparisons are presented as unadjusted and adjusted (MEESSI risk score) hazard ratios (uHR/aHR) for G1 compared to G2 patients, also estimated by weeks. Stratified analysis by EAA (provided/not provided) and patient disposition (discharged/hospitalised) was performed. Results We included 6727 patients (G1 = 3973; G2 = 2754). The 13-week mortality uHR was 1.11 (0.99-1.25; p = 0.06; with significant increases in the first 3 weeks), and the aHR was 0.91 (0.81-1.02; p = 0.11). There were no differences in unadjusted secondary post-discharge outcomes; however, G1 outcomes significantly improved after adjustment: aHR 0.83 (0.71-0.96; p = 0.01) for mortality, 0.92 (0.84-0.99; p = 0.04) for readmission, and 0.92 (0.85-0.99; p = 0.04) for the combined endpoint. We found a differentiated effect of hospitalisation (p < 0.05 for interaction; better post-discharge readmission and combined outcomes in G1), and a trend (p = 0.06) to lower mortality in G1 patients with EAA. Additionally, there were some differences between groups in baseline and acute episode characteristics. Conclusion AHF triggered by infection is not associated with a higher mid-term mortality and has better post-discharge outcomes; however, the first 3 weeks are an extremely vulnerable period. Since hospitalisation could have a role in limiting adverse post-discharge events, and EAA in reducing mortality, these relationships should be prospectively explored in further studies.
Filiaciones:
Miró Ò:
Emergency Department, Hospital Clinic, Institutd'InvestigacióBiomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.
GREAT Network, Rome, Italy.
Takagi K:
GREAT Network, Rome, Italy
Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
INSERM UMR-S 942, Paris, France
Gayat É:
INSERM UMR-S 942, Paris, France
Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Universite Paris Diderot, Paris, France
Gil V:
Emergency Department, Hospital Clinic, Institutd'InvestigacióBiomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
Llorens P:
Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Alicante, Spain
Martín-Sánchez FJ:
Emergency Department, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
Jacob J:
Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
Herrero-Puente P:
Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Escoda R:
Emergency Department, Hospital Clinic, Institutd'InvestigacióBiomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
Pilar López-Díez M:
Emergency Department, Hospital Universitario de Burgos, Burgos, Spain
:
Emergency Department, Hospital Doctor Peset, Valencia, Spain
Fuentes M:
Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
Garrido JM:
Emergency Department, Hospital Virgen de La Macarena, Sevilla, Spain
Salvo E:
Emergency Department, Hospital Universitario La Fe, Valencia, Spain
Rizzi MA:
Emergency Department, Hospital de La Santa CreuiSant Pau, Barcelona, Catalonia, Spain
Aguirre A:
Emergency Department, Hospital del Mar, Barcelona, Catalonia, Spain
Travería Bécquer L:
Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain
Domínguez-Rodríguez A:
Cardiology Department, Hospital Universitario de Canarias, Tenerife, Spain
Padrosa J:
Emergency Department, Hospital Clinic, Institutd'InvestigacióBiomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
Martínez G:
Emergency Department, Hospital Clinic, Institutd'InvestigacióBiomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
Arrigo M:
GREAT Network, Rome, Italy
Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
Freund Y:
Emergency Department, Hopital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
Mebazaa A:
GREAT Network, Rome, Italy
INSERM UMR-S 942, Paris, France
Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Universite Paris Diderot, Paris, France
Green Accepted
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