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Review
. 2023 Oct 15:389:131161.
doi: 10.1016/j.ijcard.2023.131161. Epub 2023 Jul 10.

Association of pre-hospital precipitating factors with short- and long-term outcomes of acute heart failure patients: A report from the WET-HF2 registry

Yumiko Kawakubo Ichihara  1 , Yasuyuki Shiraishi  2 , Shun Kohsaka  3 , Shintaro Nakano  4 , Yuji Nagatomo  5 , Tomohiko Ono  6 , Makoto Takei  7 , Munehisa Sakamoto  8 , Atsushi Mizuno  9 , Mitsunobu Kitamura  10 , Nozomi Niimi  11 , Takashi Kohno  12 , Tsutomu Yoshikawa  10 ; West Tokyo Heart Failure Registry
Affiliations
Review

Association of pre-hospital precipitating factors with short- and long-term outcomes of acute heart failure patients: A report from the WET-HF2 registry

Yumiko Kawakubo Ichihara et al. Int J Cardiol. .

Abstract

Background: Interest in clinical course preceding heart failure (HF) exacerbation has grown, with a greater emphasis placed on patients' clinical factors including precipitant factor (PF). Large-scale studies with precise PF documentation and temporal-outcome variation remain limited.

Methods: We reviewed prospectively collected 2412 consecutive patient-level records from a multicenter Japanese registry of hospitalized patients with HF (West Tokyo Heart Failure2 Registry: 2018-2020). Patients were categorized based on PFs: behavioral (i.e., poor adherence to physical activity, medicine, or diet regimen), treatment-required (i.e., anemia, arrhythmia, ischemia, infection, thyroid dysfunction or other conditions as suggested exacerbating factors), and no-PF. The composite outcomes of HF rehospitalization and death within 1 year after discharge and HF rehospitalization were individually assessed.

Results: Median patient age was 78 years (interquartile range: 68-85 years), and 1468 (61%) patients had documented PFs, of which 356 (15%) were considered behavioral. The behavioral PF group were younger, more male and had past HF hospitalization history compared to those in the other groups (all p < 0.05). Although risk of in-hospital death was lower in the behavioral PF group, their risk of composite outcome was not significantly different from the treatment-required group (hazard ratio [HR] 1.19 [95% confidence interval {CI} 0.93-1.51]) and the no-PF group (HR 1.28 [95%CI 1.00-1.64]). Furthermore, the risk of HF rehospitalization was higher in the behavioral PF group than in the other two groups (HR 1.40 [95%CI 1.07-1.83] and HR 1.39 [95%CI 1.06-1.83], respectively).

Conclusion: Despite a better in-hospital prognosis, patients with behavioral PFs were at significantly higher risk of HF rehospitalization.

Keywords: Heart failure; Heart failure hospitalization; Mortality; Precipitating factor.

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Conflict of interest statement

Declaration of Competing Interest Dr. Shiraishi received research grants from the SECOM Science and Technology Foundation and the Uehara Memorial Foundation, as well as honoraria from Otsuka Pharmaceutical Co. Ltd. and Ono Pharmaceutical Co. Ltd. Dr. Kohsaka received an unrestricted research grant from the Department of Cardiology at Keio University School of Medicine, Bayer Pharmaceutical Co. Ltd., Daiichi Sankyo Co. Ltd., Novartis Pharmaceutical Co. Ltd., and AstraZeneca Pharmaceutical Co. Ltd. The authors declare that they have no conflicts of interest. There are no patents, products in development, or marketed products to declare.