OBJECTIVES: To identify factors associated with worsening renal function (WRF) and explore associations with higher mortality in patients with acute heart failure (AHF). MATERIAL AND METHODS: Seven emergency departments (EDs) in the EAHFE-EFRICA study (Spanish acronym for Epidemiology of AHF in EDs - WRF in AHF) consecutively included patients with AHF and creatinine levels determined in the ED and between 24 and 48 hours later. Patients with WRF were identified by an increase in creatinine level of 0.3 mg/dL or more. Forty-seven clinical characteristics were explored to identify those associated with WRF. To analyze for 30-day all-cause mortality we calculated odds ratios (ORs). To analyze mortality at the end of follow-up and by trimester, adjusted for between-group differences, we calculated hazard ratios (HRs). The data were analyzed by subgroups according to age, sex, baseline creatinine levels, AHF type, and risk group. RESULTS: A total of 1627 patients were included. The subgroup of 220 (13.5%) with WRF were older, had higher systolic blood pressure, were more often treated with morphine, and had chronic renal failure; there was also a higher rate of hypertensive crisis as the trigger for AHF in patients with WRF. However, only chronic renal failure was independently associated with WRF (adjusted OR, 1.695; 95% CI, 1.264-2.273). The rate of 30-day mortality was 13.1% overall but higher in patients with WRF (20.9% vs 11.8% in patients without WRF; adjusted OR, 1.793; 95% CI, 1.207-2.664). Accumulated mortality at 18 months (average follow-up time, 14 mo/patient) was 40.0% overall but higher in patients with WRF (adjusted HR, 1.275; 95% CI, 1.018-1.598). Increased risk was greater in the first trimester. Subgroup analyses revealed no differences. CONCLUSION: AHF with WRF in the first 48 hours after ED care is associated with higher mortality, especially in the first trimester after the emergency.
OBJECTIVES: To identify factors associated with worsening renal function (WRF) and explore associations with higher mortality in patients with acute heart failure (AHF). MATERIAL AND METHODS: Seven emergency departments (EDs) in the EAHFE-EFRICA study (Spanish acronym for Epidemiology of AHF in EDs - WRF in AHF) consecutively included patients with AHF and creatinine levels determined in the ED and between 24 and 48 hours later. Patients with WRF were identified by an increase in creatinine level of 0.3 mg/dL or more. Forty-seven clinical characteristics were explored to identify those associated with WRF. To analyze for 30-day all-cause mortality we calculated odds ratios (ORs). To analyze mortality at the end of follow-up and by trimester, adjusted for between-group differences, we calculated hazard ratios (HRs). The data were analyzed by subgroups according to age, sex, baseline creatinine levels, AHF type, and risk group. RESULTS: A total of 1627 patients were included. The subgroup of 220 (13.5%) with WRF were older, had higher systolic blood pressure, were more often treated with morphine, and had chronic renal failure; there was also a higher rate of hypertensive crisis as the trigger for AHF in patients with WRF. However, only chronic renal failure was independently associated with WRF (adjusted OR, 1.695; 95% CI, 1.264-2.273). The rate of 30-day mortality was 13.1% overall but higher in patients with WRF (20.9% vs 11.8% in patients without WRF; adjusted OR, 1.793; 95% CI, 1.207-2.664). Accumulated mortality at 18 months (average follow-up time, 14 mo/patient) was 40.0% overall but higher in patients with WRF (adjusted HR, 1.275; 95% CI, 1.018-1.598). Increased risk was greater in the first trimester. Subgroup analyses revealed no differences. CONCLUSION: AHF with WRF in the first 48 hours after ED care is associated with higher mortality, especially in the first trimester after the emergency.
Authors: Òscar Miró; Miguel Benito-Lozano; Pedro Lopez-Ayala; Sergio Rodríguez; Pere Llorens; Ana Yufera-Sanchez; Javier Jacob; Lissete Traveria; Ivo Strebel; Víctor Gil; Josep Tost; Maria de Los Angeles López-Hernández; Aitor Alquézar-Arbé; Begoña Espinosa; Christian Mueller; Guillermo Burillo-Putze Journal: J Gen Intern Med Date: 2022-08-08 Impact factor: 6.473
Authors: Miguel Benito-Lozano; Pedro López-Ayala; Sergio Rodríguez; Víctor Gil; Pere Llorens; Ana Yufera; Javier Jacob; Lissete Travería-Becker; Ivo Strebel; Francisco Javier Lucas-Imbernon; Josep Tost; Ángeles López-Hernández; Beatriz Rodríguez; Marta Fuentes; Susana Sánchez-Ramón; Sergio Herrera-Mateo; Alfons Aguirre; M Isabel Alonso; José Pavón; M Luisa López-Grima; Begoña Espinosa; Christian Mueller; Guillermo Burillo-Putze; Òscar Miró Journal: Intern Emerg Med Date: 2022-09-01 Impact factor: 5.472
Authors: Josep Masip; Marina Povar-Echeverría; William Frank Peacock; Javier Jacob; Víctor Gil; Pablo Herrero; Pere Llorens; Aitor Alquézar-Arbé; Carolina Sánchez; Francisco Javier Martín-Sánchez; Òscar Miró Journal: Intern Emerg Med Date: 2022-03-29 Impact factor: 5.472
Authors: Òscar Miró; Pia Harjola; Xavier Rossello; Víctor Gil; Javier Jacob; Pere Llorens; Francisco Javier Martín-Sánchez; Pablo Herrero; Gemma Martínez-Nadal; Sira Aguiló; María Luisa López-Grima; Marta Fuentes; José María Álvarez Pérez; Esther Rodríguez-Adrada; María Mir; Josep Tost; Lluís Llauger; Frank Ruschitzka; Veli-Pekka Harjola; Wilfried Mullens; Josep Masip; Ovidiu Chioncel; W Frank Peacock; Christian Müller; Alexandre Mebazaa Journal: Eur Heart J Acute Cardiovasc Care Date: 2021-06-30