De novo acute heart failure: Clinical features and one-year mortality in the Spanish nationwide Registry of Acute Heart Failure

Abstract

Introduction and objectives: Acute heart failure (AHF), can occur as decompensated chronic heart failure (HF) or as a first episode, "new onset". The aim of this study was to analyse the clinical characteristics and prognosis at one-year in a cohort of patients with new onset AHF.

Methods: Prospective observational study of 3,550 patients with AHF. We compared patients with new onset HF with the others. Restricting the analysis to new onset AHF patients, we analysed the clinical characteristics, readmissions, mortality and impact of left ventricular ejection fraction on the prognosis.

Results: A total of 1,105 (31%) patients fulfil the criteria for new onset AHF. These patients versus the rest, were younger, had a higher aetiology of hypertension and preserved left ventricular ejection fraction, less global comorbidity and better baseline overall functional status. After one year, mortality in new onset HF was less than chronic decompensated HF (15 vs. 27%; p<.001; respectively). Multivariate analysis showed a correlation between mortality and higher global comorbidity (hazard ratio. -HR- 1.11), renal failure (HR 1.73), higher prescription of antialdosteronics and antiaggregant (HR 2.13; 1.8; respectively). Left ventricular ejection fraction was unrelated to mortality.

Conclusions: New onset AHF shows a clinical profile and prognosis different to that of chronic decompensated HF. Higher comorbidity, renal function and treatment post-discharge predict a higher risk of mortality.

Keywords: Acute heart failure; Características clínicas; Clinical characteristics; Fracción de eyección ventricular izquierda; Insuficiencia cardiaca aguda; Insuficiencia cardiaca de novo; Left ventricular ejection fraction; New onset heart failure; Prognosis; Pronóstico.