Abstract
To investigate the relationship of ambient temperature and atmospheric pressure (AP) at patient discharge after an episode of acute heart failure (AHF) with very early post-discharge adverse outcomes. We analyzed 14,656 patients discharged after an AHF episode from 26 hospitals in 16 Spanish cities. The primary outcome was the 7-day post-discharge combined adverse event (emergency department –ED- revisit or hospitalization due to AHF, or all-cause death), and secondary outcomes were these three adverse events considered individually. Associations (adjusted for patient and demographic conditions, and length of stay -LOS- during the AHF index episode) of temperature and AP with the primary and secondary outcomes were investigated. We used restricted cubic splines to model the continuous non-linear association of temperature and AP with each endpoint. Some sensitivity analyses were performed. Patients were discharged after a median LOS of 5 days (IQR = 1–10). The highest temperature at discharge ranged from − 2 to 41.6 °C, and AP was from 892 to 1037 hPa. The 7-day post-discharge combined event occurred in 1242 patients (8.4%), with percentages of 7-day ED-revisit, hospitalization and death of 7.8%, 5.1% and 0.9%, respectively. We found no association between the maximal temperature and AP on the day of discharge and the primary or secondary outcomes. Similarly, there were no significant associations when the analyses were restricted to hospitalized patients (median LOS = 7 days, IQR = 4–11) during the index event, or when lag-1, lag-2 or the mean of the 3 post-discharge days (instead of point estimation) of ambient temperature and AP were considered. Temperature and AP on the day of patient discharge are not independently associated with the risk of very early adverse events during the vulnerable post-discharge period in patients discharged after an AHF episode.
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Acknowledgements
This study was partially supported by competitive grants from the Instituto de Salud Carlos III supported by funds from the Spanish Ministry of Health and FEDER (PI18/00393). The ICA-Research Group has received unrestricted funding from Novartis and Orion Pharma. We appreciate the high professionalism of Alicia Díaz in the data management of the EAHFE Registry. The design of the study, patient inclusion, data analysis, discussion, and final conclusions were exclusively carried out by the authors with no participation of the granters.
Members of the EAHFE Research Group: Marta Fuentes, Cristina Gil (Hospital Universitario de Salamanca), Héctor Alonso, Enrique Pérez-Llantada (Hospital Marqués de Valdecilla de Santander), Francisco Javier Martín-Sánchez, Guillermo Llopis García, Mar Suárez Cadenas (Hospital Clínico San Carlos de Madrid), Òscar Miró, Víctor Gil, Rosa Escoda, Sira Aguiló, Carolina Sánchez (Hospital Clínic de Barcelona), Javier Millán (Hospital Politénic La Fe de Valencia), José Pavón (Hospital Dr. Negrín de Las Palmas de Gran Canaria), Antonio Noval (Hospital Insular de Las Palmas de Gran Canaria), María Luisa López-Grima, Amparo Valero, María Ángeles Juan (Hospital Dr. Peset de Valencia), Alfons Aguirre, Maria Angels Pedragosa, Silvia Mínguez Masó (Hospital del Mar de Barcelona), María Isabel Alonso, Francisco Ruiz (Hospital de Valme de Sevilla), José Miguel Franco (Hospital Miguel Servet de Zaragoza), Ana Belén Mecina (Hospital de Alcorcón de Madrid), Josep Tost, Marta Berenguer, Ruxandra Donea (Consorci Sanitari de Terrassa), Susana Sánchez-Ramón, Virginia Carbajosa-Rodríguez (Hospital Universitario Rio Hortega de Valladolid), Pascual Piñera, José Andrés Sánchez-Nicolás (Hospital Reina Sofía de Murcia), Raquel Torres-Garate (Hospital Severo Ochoa de Madrid), Aitor Alquézar-Arbé, Miguel Alberto Rizzi, Sergio Herrera (Hospital de la Santa Creu y Sant Pau de Barcelona), Javier Jacob, Alex Roset, Irene Cabello, Antonio Haro (Hospital Universitari de Bellvitge de Barcelona), Fernando Richard, José María Álvarez-Pérez, María Pilar López-Diez (Hospital Universitario de Burgos), Pablo Herrero-Puente, Joaquín Vázquez-Álvarez, Belén Prieto-García, María García-García, Marta Sánchez-González (Hospital Universitario Central de Asturias de Oviedo), Pere Llorens, Patricia Javaloyes, Inmaculada Jiménez, Néstor Hernández, Begoña Espinosa, Adriana Gil, Francisca Molina, Tamara García (Hospital General de Alicante), Juan Antonio Andueza (Hospital General Universitario Gregorio Marañón de Madrid), Rodolfo Romero (Hospital Universitario de Getafe de Madrid), Martín Ruíz, Roberto Calvache (Hospital de Henares de Madrid), María Teresa Lorca-Serralta, Luis Ernesto Calderón-Jave (Hospital del Tajo de Madrid), Beatriz Amores-Arriaga, Beatriz Sierra-Bergua (Hospital Clínico Lozano Blesa de Zaragoza), Enrique Martín-Mojarro, Brigitte Silvana Alarcón-Jiménez (Hospital Sant Pau i Santa Tecla de Tarragona), Lisette Travería-Becker, Guillermo Burillo (Hospital Universitario de Canarias de Tenerife), Lluís Llauger-García, Gerard Corominas-LaSalle. (Hospital Universitari de Vic de Barcelona), Carmen Agüera-Urbano, Ana Belén García-Soto, Elisa Delgado-Padial (Hospital Costa del Sol de Marbella de Málaga), Ester Soy Ferrer, María Adroher Múñoz (Hospital Josep Trueta de Girona). José Manuel Garrido (Hospital Virgen Macarena de Sevilla), Francisco Javier Lucas-Imbernón (Hospital General Universitario de Albacete), Rut Gaya (Hospital Juan XXIII de Tarragona), Carlos Bibiano, María Mir, Beatriz Rodríguez (Hospital Infanta Leonor de Madrid), José Luis Carballo (Complejo Hospitalario Universitario de Ourense), Esther Rodríguez-Adrada, Belén Rodríguez-Miranda, Monika Vicente-Martín (Hospital Rey Juan Carlos de Móstoles de Madrid). Pere Coma-Casanova, Joan Espinach-Alvarós (Hospital San Joan de Deu de Martorell, Barcelona).
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All procedures performed in the studty were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The EAHFE Registry protocol was approved by a central Ethics Committee at the Hospital Universitario Central de Asturias (Oviedo, Spain) with the reference numbers 49/2010, 69/2011, 166/13, 160/15 and 205/17.
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Benito-Lozano, M., López-Ayala, P., Rodríguez, S. et al. Ambient temperature and atmospheric pressure at discharge as precipitating factors in immediate adverse events in patients treated for decompensated heart failure. Intern Emerg Med 17, 2045–2056 (2022). https://doi.org/10.1007/s11739-022-03078-7
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DOI: https://doi.org/10.1007/s11739-022-03078-7