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Editor’s Choice– Impact of identifying precipitating factors on 30-day mortality in acute heart failure patients

2019; Oxford University Press; Volume: 8; Issue: 7 Linguagem: Inglês

10.1177/2048872619869328

2048-8734

Xavier Rosselló, Víctor Gil, Rosa Escoda, Javier Jacob, Alfons Aguirre, Francisco Javier Martín‐Sánchez, Pere Llorens, Pablo Herrero, Miguel Alberto Rizzi, Sergio Raposeiras‐Roubín, Desiree Wussler, Christian Müller, Étienne Gayat, Alexandre Mebazaa, Òscar Miró, Marta Fuentes, Cristina Gil, Héctor Olásolo Alonso, Enrique Pérez‐Llantada, Francisco Javier Martín‐Sánchez, Guillermo García, Mar Suárez Cadenas, Òscar Miró, Víctor Gil, Rosa Escoda, Carolina Xipell, Carolina Sánchez, María José Pérez‐Durá, Eva Salvo, José Pavón, Antonio Noval, José Manuel Torres, María Luisa López‐Grima, Amparo Valero, María Ángeles Juan, Alfons Aguirre, María Àngels Pedragosa, Silvia Mínguez Masó, María Isabel Alonso, Francisco Ruiz, José Miguel Franco, Ana Belén Mecina, Josep Tost, Marta Berenguer, Ruxandra Donea, Susana Sánchez Ramón, Virginia Carbajosa Rodríguez, Pascual Piñera, José Andrés Sánchez Nicolás, Raquel Torres Gárate, Aitor Alquézar‐Arbé, Miguel Alberto Rizzi, Sergio Herrera, Javier Jacob, Àlex Roset, Irene Cabello, Antonio de Haro Bailón, Fernando Richard, José María Álvarez Pérez, María Pilar López Díez, Pablo Herrero, Joaquín Vázquez Álvarez, Belén Prieto García, María García García, Marta Sánchez González, Pere Llorens, Patricia Javaloyes, Víctor Marquina, Inmaculada Mora-Jiménez, Néstor Hernández, Benjamín Brouzet, Begoña Espinosa, Juan Antonio Andueza, Rodolfo Romero, Martín Ruíz, Roberto Calvache, María Teresa Lorca Serralta, Luis Ernesto Calderón Jave, Beatriz Amores Arriaga, Beatriz Sierra Bergua, Enrique Martín Mojarro, Brigitte Silvana Alarcón Jiménez, LisetteTravería Bécquer, Guillermo Burillo, Lluís Llauger García, Gerard Corominas LaSalle, Carmen Agüera Urbano, Ana Belén García Soto, Elisa Delgado Padial, Ester Soy Ferrer, José Manuel Garrido, Francisco Javier Lucas-Imbernón, Rut Gaya, Carlos Bibiano, María Mir, Beatriz L. Rodríguez, José Luís Carballo, Esther Rodríguez‐Adrada, Belén Rodríguez Miranda,

Cardiac Arrest and Resuscitation

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.