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Observational Study
. 2019 Oct;8(7):667-680.
doi: 10.1177/2048872619869328. Epub 2019 Aug 22.

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

Xavier Rossello  1   2 , Víctor Gil  3 , Rosa Escoda  3 , Javier Jacob  4 , Alfons Aguirre  5 , Francisco J Martín-Sánchez  1   6 , Pere Llorens  7 , Pablo Herrero Puente  8 , Miguel Rizzi  9 , Sergio Raposeiras-Roubín  10 , Desiree Wussler  11 , Christian E Müller  11   12 , Etienne Gayat  13 , Alexandre Mebazaa  12   13 , Òscar Miró  3   12 ; ICA-SEMES Research Group
Collaborators, Affiliations
Observational Study

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

Xavier Rossello et al. Eur Heart J Acute Cardiovasc Care. 2019 Oct.

Abstract

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.

Keywords: Acute heart failure; mortality; outcome; precipitant factors.

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