Factors associated with in-hospital mortality and adverse outcomes during the vulnerable post-discharge phase after the first episode of acute heart failure: results of the NOVICA-2 study
Por:
Rizzi, M, Sarasola, A, Arbe, A, Mateo, S, Gil, V, Llorens, P, Jacob, J, Martin-Sanchez, F, Puente, P, Escoda, R, Espinosa, B, Roset, A, Torres-Garate, R, Torres-Murillo, J, Mecina, A, Lopez-Diez, M, Perez, J, Tost, J, Salvo, E, Lopez-Grima, M, Gil, C, Mir, M, Rutzinska, F, Chioncel, O, Miro, O and ICA-SEMES Res Grp
Publicada:
1 jul 2021
Ahead of Print:
1 sep 2020
Resumen:
Objective To identify patients at risk of in-hospital mortality and adverse outcomes during the vulnerable post-discharge period after the first acute heart failure episode (de novo AHF) attended at the emergency department.
Methods This is a secondary review of de novo AHF patients included in the prospective, multicentre EAHFE (Epidemiology of Acute Heart Failure in Emergency Department) Registry. We included consecutive patients with de novo AHF, for whom 29 independent variables were recorded. The outcomes were in-hospital all-cause mortality and all-cause mortality and readmission due to AHF within 90 days post-discharge. A follow-up check was made by reviewing the hospital medical records and/or by phone.
Results We included 3422 patients. The mean age was 80 years, 52.1% were women. The in-hospital mortality was 6.9% and was independently associated with dementia (OR = 2.25, 95% CI = 1.62-3.14), active neoplasia (1.97, 1.41-2.76), functional dependence (1.58, 1.02-2.43), chronic treatment with beta-blockers (0.62, 0.44-0.86) and severity of decompensation (6.38, 2.86-14.26 for high-/very high-risk patients). The 90-day post-discharge combined endpoint was observed in 19.3% of patients and was independently associated with hypertension (HR = 1.40, 1.11-1.76), chronic renal insufficiency (1.23, 1.01-1.49), heart valve disease (1.24, 1.01-1.51), chronic obstructive pulmonary disease (1.22, 1.01-1.48), NYHA 3-4 at baseline (1.40, 1.12-1.74) and severity of decompensation (1.23, 1.01-1.50; and 1.64, 1.20-2.25; for intermediate and high-/very high-risk patients, respectively), with different risk factors for 90-day post-discharge mortality or rehospitalisation.
Conclusions The severity of decompensation and some baseline characteristics identified de novo AHF patients at increased risk of developing adverse outcomes during hospitalisation and the vulnerable post-discharge phase, without significant differences in these risk factors according to patient age at de novo AHF presentation.
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Filiaciones:
Rizzi, M:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Sarasola, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Arbe, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Mateo, S:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Gil, V:
Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Spain
:
Miguel Hernandez Univ, Hosp Gen Alicante, Emergency Dept, Short Stay Unit & Hospitalizat Home, Alicante, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Spain
Martin-Sanchez, F:
Univ Complutense Madrid, Emergency Dept, Hosp Clin San Carlos, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Madrid, Spain
Puente, P:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Spain
Escoda, R:
Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Spain
:
Miguel Hernandez Univ, Hosp Gen Alicante, Emergency Dept, Short Stay Unit & Hospitalizat Home, Alicante, Spain
Roset, A:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Spain
Torres-Garate, R:
Hosp Univ Severo Ochoa de Leganes, Emergency Dept, Madrid, Spain
Torres-Murillo, J:
Hosp Univ Nuestra Senora de Valme, Emergency Dept, Seville, Spain
Mecina, A:
Hosp Univ Fdn Alcorcon, Emergency Dept, Madrid, Spain
Lopez-Diez, M:
Hosp Univ Burgos, Emergency Dept, Burgos, Spain
Perez, J:
Hosp Univ Burgos, Emergency Dept, Burgos, Spain
Tost, J:
Hosp Terrassa, Emergency Dept, Barcelona, Spain
Salvo, E:
Hosp Univ La Fe, Emergency Dept, Valencia, Spain
Lopez-Grima, M:
Hosp Doctor Peset, Emergency Dept, Valencia, Spain
Gil, C:
Hosp Univ Salamanca, Emergency Dept, Salamanca, Spain
Mir, M:
Hosp Infanta Leonor, Emergency Dept, Madrid, Spain
Rutzinska, F:
Hosp Univ Salamanca, Emergency Dept, Salamanca, Spain
Chioncel, O:
Hosp Infanta Leonor, Emergency Dept, Madrid, Spain
Miro, O:
Univ Barcelona, Hosp Clin, Emergency Dept, Barcelona, Spain
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