Òscar Miró1, Alfons Aguirre2, Pablo Herrero3, Javier Jacob4, Francisco Javier Martín-Sánchez5, Pere Llorens6. 1. Área de Urgencias, Hospital Clínic, Barcelona. Grupo de investigación «Urgencias: Procesos y Patologías», IDIBAPS, Barcelona, España. Electronic address: omiro@clinic.ub.es. 2. Servicio de Urgencias, Hospital del Mar, Barcelona, España. 3. Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España. 4. Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. 5. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, España. 6. Servicio de Urgencias Departamentales, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital General de Alicante, Alicante, España.
Abstract
OBJECTIVE: To evaluate the precipitating factors (PF) associated with acute heart failure and their association with medium-term prognosis. PATIENTS AND METHODS: Multipurpose prospective study from the EAHFE Registry. We included as PF: infection, rapid atrial fibrillation (RAF), anaemia, hypertensive crisis, non-adherence to diet or drug therapy and non-ST-segment-elevation acute coronary syndrome (NSTEACS). Patients without PF were control group. Hazard ratios (HR) crudes and adjusted for reconsultations and mortality at 90 days were calculated. RESULTS: 3535 patients were included: 28% without and 72% with PF. Patients with RAF (HR 0.67; 95%CI 0.50-0.89) and hypertensive crisis (HR 0.45; 95%CI 0.28-0.72) had less mortality and patients with NSTEACS (HR 1.79; 95%CI 1.19-2.70) had more mortality. Reconsultation was fewer in patients with infection (HR 0.74; 95%CI 0.64-0.85), RAF (HR 0.69; 95%CI 0.58-0.83) and hypertensive crisis (HR 0.71; 95%CI 0.55-0.91). These differences were maintained in all the adjusted models except for hypertensive crisis. CONCLUSIONS: One PF is identified in 3 out of 4 patients and it may influence medium-term prognosis. At 90 days, NSTEACS and RAF were associated with more and less mortality respectively, and RAF and infection with less probability of reconsultation.
OBJECTIVE: To evaluate the precipitating factors (PF) associated with acute heart failure and their association with medium-term prognosis. PATIENTS AND METHODS: Multipurpose prospective study from the EAHFE Registry. We included as PF: infection, rapid atrial fibrillation (RAF), anaemia, hypertensive crisis, non-adherence to diet or drug therapy and non-ST-segment-elevation acute coronary syndrome (NSTEACS). Patients without PF were control group. Hazard ratios (HR) crudes and adjusted for reconsultations and mortality at 90 days were calculated. RESULTS: 3535 patients were included: 28% without and 72% with PF. Patients with RAF (HR 0.67; 95%CI 0.50-0.89) and hypertensive crisis (HR 0.45; 95%CI 0.28-0.72) had less mortality and patients with NSTEACS (HR 1.79; 95%CI 1.19-2.70) had more mortality. Reconsultation was fewer in patients with infection (HR 0.74; 95%CI 0.64-0.85), RAF (HR 0.69; 95%CI 0.58-0.83) and hypertensive crisis (HR 0.71; 95%CI 0.55-0.91). These differences were maintained in all the adjusted models except for hypertensive crisis. CONCLUSIONS: One PF is identified in 3 out of 4 patients and it may influence medium-term prognosis. At 90 days, NSTEACS and RAF were associated with more and less mortality respectively, and RAF and infection with less probability of reconsultation.
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