Editor’s Choice– Impact of identifying precipitating factors on 30-day mortality in acute heart failure patients

Abstract

Background: The aim of this study was to describe the prevalence and prognostic value of the most common triggering factors in acute heart failure. Methods: Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in three time periods between 2011 and 2016. Precipitating factors were classified as: (a) unrecognized; (b) infection; (c) atrial fibrillation; (d) anaemia; (e) hypertension; (f) acute coronary syndrome; (g) non-adherence; and (h) two or more precipitant factors. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and each precipitant factor. The risk of dying was further evaluated by week intervals over the 30-day follow-up to assess the period of higher vulnerability for each precipitant factor. Results: Approximately 69% of our 9999 patients presented with a triggering factor and 1002 died within the first 30 days (10.0%). The most prevalent factors were infection and atrial fibrillation. After adjusting for 11 known predictors, acute coronary syndrome was associated with higher 30-day mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.02–3.42), whereas atrial fibrillation (OR 0.75; 95% CI 0.56–0.94) and hypertension (OR 0.34; 95% CI 0.21–0.55) were significantly associated with better outcomes when compared to patients without precipitant. Patients with infection, anaemia and non-compliance were not at higher risk of dying within 30 days. These findings were consistent across gender and age groups. The 30-day mortality time pattern varied between and within precipitant factors. Conclusions: Precipitant factors in acute heart failure patients are prevalent and have a prognostic value regardless of the patient’s gender and age. They can be managed with specific treatments and can sometimes be prevented.

Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review

“…Among the 761 screened citations, 28 studies published over the last 10 years 8,20,24,35–59 met the inclusion criteria after full-text review (Figure 1). These 28 studies included 19 different risk models that had been used in AHF patients in the ED setting to predict clinical outcomes (Table 1).…”

“…20,35,39,54–59,62 In addition, nine studies used at least one risk score to define the severity of AHF decompensation, to produce subgroups of patients based on their risk or to adjust in multivariate regressions (to reduce the impact of confounding factors). 8,24,36,45–50 In one of them, the comparison between discharged and hospitalised patients at similar predicted risk (using the risk model developed by Lee et al.) 24 demonstrated a higher 90-day mortality for patients discharged home from the ED.…”

“…In connection with this clinical use, the use of these scales to select or stratify patients included in trials before their randomization, or to adjust after their intervention allocation, may avoid the current excessive patient heterogeneity described in recent randomised clinical trials failing to demonstrate clinical benefits. 48,66,67…”

Prognostic Implications of Reductions in Heart Rates in Patients With Acute Heart Failure and Atrial Fibrillation

“…[4][5][6] Atrial fibrillation (AF) is the most common arrhythmia seen in patients with AHF, and approximately 35-40% of AHF patients have a history of AF at the time of admission. [7][8][9][10] It has also been reported that AF is the second most common precipitating factor of AHF. 11 Although T he impact of heart rate (HR) on prognosis in patients with chronic heart failure (HF) has been extensively investigated, and a lower HR is associated with lower rates of adverse events.…”

East meets West on acute heart failure

“…An analysis of the data from an extensive Spanish multicentre registry on the epidemiology of acute heart failure in emergency departments (EAHFE) assessed the prevalence and prognostic value of the most common triggering factors in acute heart failure. 16 Infection and atrial fibrillation were the most common precipitants. Among all precipitant factors, an acute coronary syndrome was associated with a markedly increased 30-day mortality, whereas infection and atrial fibrillation were associated with better outcomes.…”