Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Grants from Region Östergötland County Medical Research Council of South East Sweden. Introduction The use of NT-proBNP is well established in the management of heart failure (HF), and as predictor of mortality in HF patients. However, on short-term mortality in acute decompensated heart failure the evidence is scarce. Purpose We aimed to evaluate NT-proBNP as an independent predictor of 30-day all-cause mortality in acute decompensated heart failure patients, seeking emergency medical care. Methods This was an observational study including all visits to Vrinnevisjukhuset hospital emergency department during two years, where the patient was above 18 years of age, and the main diagnosis was set to HF. Appropriate data for each visit were collected from the patients’ medical records retrospectively. The Cox proportional hazards model was applied to estimate hazard ratios (HR) for 30-day mortality. Results From the 459 emergency department visits included in the study 59 patients (12,9%) reached the primary end point of all-cause mortality in 30 days. Age, body mass index (BMI), mean arterial pressure (MAP), sodium, potassium, NT-proBNP, and the presence of atrial fibrillation or flutter were variables achieving P<0.1 on univariate Cox proportional hazards analysis and were subsequently introduced to the multivariate model. Age (HR: 1,05; p=0,008), sodium (HR: 0,925; p=0,012), potassium (HR: 1,95; p=0,002) and MAP (HR: 0,978; p=0,009) was found to be the only independent predictors of 30-day all-cause mortality. Conclusions Our study indicates that for short-term prediction of mortality, other markers than NT-proBNP are of significance. Measurement of serum potassium might be a better tool for clinicians in identifying patients at highest risk of short-term mortality.

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Grants from Region Östergötland County Medical Research Council of Southeast Sweden Background Atrial fibrillation/flutter (AF) is a common heart arrhythmia and medical condition at the emergency room, making up approximately 1-2% of the visits and hospital admissions. Previous studies have shown an association between elevated Troponin-T levels and mortality (1). However, there is limited data in whether mildly elevated Troponin-T levels together with age correlates with an increased mortality. Purpose The purpose of this study was to analyse the usage of Troponin-T and its prognostic value for mortality together with age in patients with AF at the emergency department. Methods A comparison of when Troponin-T was used and when multiple sampling occurred was made. A comparison of Troponin-T together with age was also made to analyse potential associations with mortality. Patients were identified through the ICD-10 code for AF (I48) and the data was collected through medical records and diagnostic registers. Patients were divided in three groups based on Troponin-T (< 15 ng/L, 15-50 ng/L and > 50 ng/L) and four subgroups based on age (< 60, 60-69, 70-79 and > 80 years). Primary outcomes were all-cause mortality at 30 days and 1 year. The association between Troponin-T, age and mortality were analysed through hazard ratio (HR) with 95% confidence interval (CI). Results 771 patients with AF at the emergency room were included in this cohort study (median age 72, 44,6% female and median AF duration 1,3 years). There was a significant difference in Troponin-T levels between patients admitted to hospital compared to discharge (p < 0,001). All-cause mortality was 1,9% (n = 15) at 1 month and 7,7% (n = 59) at 1 year. The hazard ratio (HR) was 9,86 (95% CI 1,23-78,82, p = 0,031) for Troponin-T 15-50 ng/L and 32,98 (95% CI 3,85-282,29, p < 0,001) for Troponin-T > 50 ng/L at 30 days compared to Troponin-T < 15 ng/L. The HR at 1 year was 7,98 (95% CI 3,10-20,51, p < 0,001) for Troponin-T 15-50 ng/L and 20,88 (95% CI 7,52-57,98, p < 0,001) for Troponin-T > 50 ng/L compared to Troponin-T < 15 ng/L. For age, the HR at 1 year was 2,67 (95% CI 0,54-13,23, p = 0,229) for age 60-69 years, 3,59 (95% CI 0,82-15,80, p = 0,091) for age 70-79 years and 12,79 (95% CI 3,05-53,68, p < 0,001) for age > 80 years compared to age < 60 years. Conclusions Troponin-T appears to influence several decisions taken at the emergency room for patients with AF, such as whether admission or multiple sampling is required. Troponin-T and age appears to independently indicate the risk for all-cause mortality. Higher Troponin-T were also associated with increased mortality in most age groups.