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, F, Llorens P, Puente, P, Rizzi, M, Raposeiras-Roubin, S, Wussler, D, Muller, C, Gayat, E, Mebazaa, A, Miro, O, Fuentes, M, Gil, C, Alonso, H, Perez-Llantada, E, Martin-Sanchez, F, Garcia, G, Cadenas, M, Xipell, C, Sanchez, C, Perez-Dura, M, Salvo, E, Pavon, J, Noval, A, Tones, J, Lopez-Grima, M, Valero, A, Juan, M, Pedragosa, M, Maso, S, Alonso, M, Ruiz, F, Franco, J, Mecina, A, Tost, J, Berenguer, M, Donea, R, Ramon, S, Rodriguez, V, Pinera, P, Nicolas, J, Garate, R, Alquezar-Arbe, A, Rizzi, M, Herrera, S, Roset, A, Cabello, I, Haro, A, Richard, F, Perez, J, Diez, M, Alvarez, J, Garcia, B, Garcia, M, Gonzalez, M, Javaloyes P, Marquina V, Jimenez I, Hernandez N, Brouzet T, Espinosa B, Andueza, J, Romero, R, Ruiz, M, Calvache, R, Serralta, M, Jave, L, Arriaga, B, Bergua, B, Mojarro, E, Jimenez, B, Becquer, L, Burillo, G, Garcia, L, LaSalle, G, Urbano, C, Soto, A, Padial, E, Ferrer, E, Garrido, J, Lucas-Imbernon, F, Gaya, R, Bibiano, C, Mir, M, Rodriguez, B, Carballo, J, Rodriguez-Adrada, E, Miranda, B and ICA-SEMES Res Grp
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, F:
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, P:
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, C:
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, F:
Hosp Clin San Carlos Madrid, Madrid, Spain
Garcia, G:
Hosp Clin San Carlos Madrid, Madrid, Spain
Cadenas, M:
Hosp Clin San Carlos Madrid, Madrid, Spain
Xipell, C:
Hosp Clin Barcelona, Barcelona, Spain
Sanchez, C:
Hosp Clin Barcelona, Barcelona, Spain
Perez-Dura, M:
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, J:
Hosp Reina Sofia Cordoba, Cordoba, Spain
:
Hosp Dr Peset Valencia, Valencia, Spain
:
Hosp Dr Peset Valencia, Valencia, Spain
:
Hosp Dr Peset Valencia, Valencia, Spain
Pedragosa, M:
Hosp Mar Barcelona, Barcelona, Spain
Maso, S:
Hosp Mar Barcelona, Barcelona, Spain
Alonso, M:
Hosp Valme Sevilla, Seville, Spain
Ruiz, F:
Hosp Valme Sevilla, Seville, Spain
Franco, J:
Hosp Miguel Servet Zaragoza, Zaragoza, Spain
Mecina, A:
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, S:
Hosp Univ Rio Hortega Valladolid, Valladolid, Spain
Rodriguez, V:
Hosp Univ Rio Hortega Valladolid, Valladolid, Spain
Pinera, P:
Hosp Reina Sofia Murcia, Murcia, Spain
Nicolas, J:
Hosp Reina Sofia Murcia, Murcia, Spain
Garate, R:
Hosp Severo Ochoa Madrid, Madrid, Spain
Alquezar-Arbe, A:
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Rizzi, M:
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, J:
Hosp Univ Burgos, Burgos, Spain
Diez, M:
Hosp Univ Burgos, Burgos, Spain
Alvarez, J:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Garcia, B:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Garcia, M:
Hosp Univ Cent Asturias Oviedo, Oviedo, Spain
Gonzalez, M:
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 T:
Hosp Gen Alicante, Alicante, Spain
Espinosa B:
Hosp Gen Alicante, Alicante, Spain
Andueza, J:
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, M:
Hosp Tajo Madrid, Madrid, Spain
Jave, L:
Hosp Tajo Madrid, Madrid, Spain
Arriaga, B:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Bergua, B:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Mojarro, E:
Hosp St Pau & Santa Tecla Tarragona, Tarragona, Spain
Jimenez, B:
Hosp St Pau & Santa Tecla Tarragona, Tarragona, Spain
Becquer, L:
Hosp Univ Canarias Tenerife, Tenerife, Spain
Burillo, G:
Hosp Univ Canarias Tenerife, Tenerife, Spain
Garcia, L:
Hosp Univ Vic Barcelona, Barcelona, Spain
LaSalle, G:
Hosp Univ Vic Barcelona, Barcelona, Spain
Urbano, C:
Hosp Costa del Sol Marbella Malaga, Malaga, Spain
Soto, A:
Hosp Costa del Sol Marbella Malaga, Malaga, Spain
Padial, E:
Hosp Costa del Sol Marbella Malaga, Malaga, Spain
Ferrer, E:
Hosp Josep Trueta Girona, Girona, Spain
Garrido, J:
Hosp Virgen Macarena Sevilla, Seville, Spain
Lucas-Imbernon, F:
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, J:
Complejo Hosp Univ Ourense, Orense, Spain
Rodriguez-Adrada, E:
Hosp Rey Juan Carlos Mostoles Madrid, Madrid, Spain
Miranda, B:
Hosp Rey Juan Carlos Mostoles Madrid, Madrid, Spain
Open Access
|