Òscar Miró1,2, Koji Takagi3,4,5, Étienne Gayat5,6, Víctor Gil7, Pere Llorens8, Francisco J Martín-Sánchez9, Javier Jacob10, Pablo Herrero-Puente11, Rosa Escoda7, María Pilar López-Díez12, Amparo Valero13, Marta Fuentes14, José M Garrido15, Eva Salvo16, Miguel A Rizzi17, Alfons Aguirre18, Lissete Travería Bécquer19, Alberto Domínguez-Rodríguez20, Joan Padrosa7, Gemma Martínez7, Mattia Arrigo3,21, Yonathan Freund22, Alexandre Mebazaa3,5,6. 1. Emergency Department, Hospital Clinic, Institutd'InvestigacióBiomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain. omiro@clinic.cat. 2. GREAT Network, Rome, Italy. omiro@clinic.cat. 3. GREAT Network, Rome, Italy. 4. Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan. 5. INSERM UMR-S 942, Paris, France. 6. Department of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Universite Paris Diderot, Paris, France. 7. Emergency Department, Hospital Clinic, Institutd'InvestigacióBiomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain. 8. Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Alicante, Spain. 9. Emergency Department, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain. 10. Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain. 11. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain. 12. Emergency Department, Hospital Universitario de Burgos, Burgos, Spain. 13. Emergency Department, Hospital Doctor Peset, Valencia, Spain. 14. Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain. 15. Emergency Department, Hospital Virgen de La Macarena, Sevilla, Spain. 16. Emergency Department, Hospital Universitario La Fe, Valencia, Spain. 17. Emergency Department, Hospital de La Santa CreuiSant Pau, Barcelona, Catalonia, Spain. 18. Emergency Department, Hospital del Mar, Barcelona, Catalonia, Spain. 19. Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain. 20. Cardiology Department, Hospital Universitario de Canarias, Tenerife, Spain. 21. Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland. 22. Emergency Department, Hopital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.
Abstract
OBJECTIVE: To investigate whether patients with an acute heart failure (AHF) episode triggered by infection present different outcomes compared to patients with no trigger and the effects of early antibiotic administration (EAA) and hospitalisation. METHODS: Two groups were made according to the AHF trigger: infection (G1) or none identified (G2). The primary outcome was 13-week (91-days) all-cause mortality, and secondary outcomes were 13-week post-discharge mortality, readmission or combined endpoint. Comparisons are presented as unadjusted and adjusted (MEESSI risk score) hazard ratios (uHR/aHR) for G1 compared to G2 patients, also estimated by weeks. Stratified analysis by EAA (provided/not provided) and patient disposition (discharged/hospitalised) was performed. RESULTS: We included 6727 patients (G1 = 3973; G2 = 2754). The 13-week mortality uHR was 1.11 (0.99-1.25; p = 0.06; with significant increases in the first 3 weeks), and the aHR was 0.91 (0.81-1.02; p = 0.11). There were no differences in unadjusted secondary post-discharge outcomes; however, G1 outcomes significantly improved after adjustment: aHR 0.83 (0.71-0.96; p = 0.01) for mortality, 0.92 (0.84-0.99; p = 0.04) for readmission, and 0.92 (0.85-0.99; p = 0.04) for the combined endpoint. We found a differentiated effect of hospitalisation (p < 0.05 for interaction; better post-discharge readmission and combined outcomes in G1), and a trend (p = 0.06) to lower mortality in G1 patients with EAA. Additionally, there were some differences between groups in baseline and acute episode characteristics. CONCLUSION: AHF triggered by infection is not associated with a higher mid-term mortality and has better post-discharge outcomes; however, the first 3 weeks are an extremely vulnerable period. Since hospitalisation could have a role in limiting adverse post-discharge events, and EAA in reducing mortality, these relationships should be prospectively explored in further studies.
OBJECTIVE: To investigate whether patients with an acute heart failure (AHF) episode triggered by infection present different outcomes compared to patients with no trigger and the effects of early antibiotic administration (EAA) and hospitalisation. METHODS: Two groups were made according to the AHF trigger: infection (G1) or none identified (G2). The primary outcome was 13-week (91-days) all-cause mortality, and secondary outcomes were 13-week post-discharge mortality, readmission or combined endpoint. Comparisons are presented as unadjusted and adjusted (MEESSI risk score) hazard ratios (uHR/aHR) for G1 compared to G2 patients, also estimated by weeks. Stratified analysis by EAA (provided/not provided) and patient disposition (discharged/hospitalised) was performed. RESULTS: We included 6727 patients (G1 = 3973; G2 = 2754). The 13-week mortality uHR was 1.11 (0.99-1.25; p = 0.06; with significant increases in the first 3 weeks), and the aHR was 0.91 (0.81-1.02; p = 0.11). There were no differences in unadjusted secondary post-discharge outcomes; however, G1 outcomes significantly improved after adjustment: aHR 0.83 (0.71-0.96; p = 0.01) for mortality, 0.92 (0.84-0.99; p = 0.04) for readmission, and 0.92 (0.85-0.99; p = 0.04) for the combined endpoint. We found a differentiated effect of hospitalisation (p < 0.05 for interaction; better post-discharge readmission and combined outcomes in G1), and a trend (p = 0.06) to lower mortality in G1 patients with EAA. Additionally, there were some differences between groups in baseline and acute episode characteristics. CONCLUSION: AHF triggered by infection is not associated with a higher mid-term mortality and has better post-discharge outcomes; however, the first 3 weeks are an extremely vulnerable period. Since hospitalisation could have a role in limiting adverse post-discharge events, and EAA in reducing mortality, these relationships should be prospectively explored in further studies.
Authors: Òscar Miró; Alfons Aguirre; Pablo Herrero; Javier Jacob; Francisco Javier Martín-Sánchez; Pere Llorens Journal: Med Clin (Barc) Date: 2015-03-24 Impact factor: 1.725
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Authors: Pere Llorens; Patricia Javaloyes; Francisco Javier Martín-Sánchez; Javier Jacob; Pablo Herrero-Puente; Víctor Gil; José Manuel Garrido; Eva Salvo; Marta Fuentes; Héctor Alonso; Fernando Richard; Francisco Javier Lucas; Héctor Bueno; John Parissis; Christian E Müller; Òscar Miró Journal: Clin Res Cardiol Date: 2018-05-04 Impact factor: 5.460
Authors: A Hermida Ameijeiras; M Pazo Núñez; R de la Fuente Cid; F L Lado Lado; L Hernández Fernández; I Rodríguez López Journal: An Med Interna Date: 2008-06
Authors: Francisco J Martín-Sánchez; Michael Christ; Òscar Miró; W Frank Peacock; John J McMurray; Héctor Bueno; Alan S Maisel; Louise Cullen; Martin R Cowie; Salvatore Di Somma; Elke Platz; Josep Masip; Uwe Zeymer; Christiaan Vrints; Susanna Price; Christian Mueller Journal: Int J Cardiol Date: 2016-07-18 Impact factor: 4.164
Authors: Piotr Ponikowski; Adriaan A Voors; Stefan D Anker; Héctor Bueno; John G F Cleland; Andrew J S Coats; Volkmar Falk; José Ramón González-Juanatey; Veli-Pekka Harjola; Ewa A Jankowska; Mariell Jessup; Cecilia Linde; Petros Nihoyannopoulos; John T Parissis; Burkert Pieske; Jillian P Riley; Giuseppe M C Rosano; Luis M Ruilope; Frank Ruschitzka; Frans H Rutten; Peter van der Meer Journal: Eur Heart J Date: 2016-05-20 Impact factor: 29.983
Authors: Òscar Miró; Xavier Rossello; Elke Platz; Josep Masip; Danielle M Gualandro; W Frank Peacock; Susanna Price; Louise Cullen; Salvatore DiSomma; Mucio Tavares de Oliveira; John Jv McMurray; Francisco J Martín-Sánchez; Alan S Maisel; Christiaan Vrints; Martin R Cowie; Héctor Bueno; Alexandre Mebazaa; Christian Mueller Journal: Eur Heart J Acute Cardiovasc Care Date: 2020-08