Abstract
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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Change history
23 December 2020
A Correction to this paper has been published: https://doi.org/10.1007/s00392-020-01772-0
References
Lombardi CM, Ferreira JP, Carubelli V, Anker SD, Cleland JG, Dickstein K et al (2020) Geographical differences in heart failure characteristics and treatment across Europe: results from the BIOSTAT-CHF study. Clin Res Cardiol 109:967–977. https://doi.org/10.1007/s00392-019-01588-7
O'Connor CM, Miller AB, Blair JE, Konstam MA, Wedge P, Bahit MC et al (2010) Causes of death and rehospitalization in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction: results from Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) program. Am Heart J 159(841–9):e1
Krumholz HM (2013) Post-hospital syndrome–an acquired, transient condition of generalized risk. N Engl J Med 368:100–102
Farmakis D, Parissis J, Lekakis J, Filippatos G (2015) Insuficiencia cardiaca aguda: epidemiología, factores de riesgo y prevención. Rev Esp Cardiol 68:245–248
Llorens P (2018) Risk assessment in emergency department patients with acute heart failure: we need to reach beyond our clinical judgment. Emergencias 30:75–76
Allen CJ, Guha K, Sharma R (2015) How to improve time to diagnosis in acute heart failure-clinical signs and chest x-ray. Cardiac Fail Rev 1:69
Miró Ò, García Sarasola A, Fuenzalida C, Calderón S, Jacob J, Aguirre A et al (2019) Departments involved during the first episode of acute heart failure and analysis of emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort. Eur J Heart Fail 21:1231–1244
Formiga F, Chivite D (2018) Acute heart failure: understanding the patient is essential. Emergencias 30:145
Chioncel O, Mebazaa A, Harjola VP, Coats AJ, Piepoli MF, Crespo-Leiro MG et al (2017) Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC heart failure long-term registry. Eur J Heart Fail 19:1242–1254
Tu JV, Donovan LR, Lee DS, Wang JT, Austin PC, Alter DA et al (2009) Effectiveness of public report cards for improving the quality of cardiac care: the EFFECT study: a randomized trial. JAMA 302:2330–2337
Franco J, Formiga F, Corbella X, Conde-Martel A, Llácer P, Rocha PÁ et al (2019) Insuficiencia cardiaca aguda de novo: características clínicas y mortalidad al año en el Registro Español de Insuficiencia Cardiaca Aguda. Med Clín 152:127–134
Miro O, Levy PD, Mockel M, Pang PS, Lambrinou E, Bueno H et al (2017) Disposition of emergency department patients diagnosed with acute heart failure: an international emergency medicine perspective. Eur J Emerg Med 24:2–12
Masip J (2019) Is the MEESSI-AHF score for multiple estimation of risk based on the Spanish emergency department score in patients with acute heart failure an effective basis for discharging patients with AHF? Emergencias 31:3–4
García Sarasola AAAA, Gil V, Jacob J Llorens P, Rizzi MA et al (2019) NOVICA: características y evolución en los pacientes que presentan un primer episodio de insuficiencia cardiaca (de novo). Rev Esp Cardiol. 219:469–473
Llorens P, Javaloyes P, Martin-Sanchez FJ, Jacob J, Herrero-Puente P, Gil V et al (2018) Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure. Clin Res Cardiol 107:897–913
Miro O, Gil V, Rossello X, Martin-Sanchez FJ, Llorens P, Jacob J et al (2019) Patients with acute heart failure discharged from the emergency department and classified as low risk by the MEESSI score (multiple risk estimate based on the Spanish emergency department scale): prevalence of adverse events and predictability. Emergencias 31:5–14
Ho KK, Pinsky JL, Kannel WB, Levy D (1993) The epidemiology of heart failure: the Framingham study. J Am Coll Cardiol 22:6A–13A
Miro O, Rossello X, Gil V, Martin-Sanchez FJ, Llorens P, Herrero-Puente P et al (2017) Predicting 30-day mortality for patients with acute heart failure in the emergency department: a cohort study. Ann Intern Med 167:698–705
Greene SJ, Fonarow GC, Vaduganathan M, Khan SS, Butler J, Gheorghiade M (2015) The vulnerable phase after hospitalization for heart failure. Nat Rev Cardiol 12:220–229
Miró Ò, Hazlitt M, Escalada X, Llorens P, Gil V, Martín-Sánchez FJ et al (2018) Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study. Clin Res Cardiol 107(4):347–361
Shoaib A, Farag M, Nolan J, Rigby A, Patwala A, Rashid M et al (2019) Mode of presentation and mortality amongst patients hospitalized with heart failure? a report from the first euro heart failure survey. Clin Res Cardiol 108(5):510–519
Leto L, Feola M (2014) Cognitive impairment in heart failure patients. J Geriatr Cardiol 11:316–328
Miró Ò, Llorens P, Martín-Sánchez FJ, Herrero P, Pavón J, Pérez-Durá MJ et al (2009) Short-term prognostic factors in elderly patients seen in emergency departments for acute heart failure. Rev Esp Cardiol (Engl Ed) 62:757–764
Vogels RL, Scheltens P, Schroeder-Tanka JM, Weinstein HC (2007) Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail 9:440–449
Martin-Sanchez FJ, Rodriguez-Adrada E, Vidan MT, Diez Villanueva P, Llopis Garcia G, Gonzalez Del Castillo J et al (2018) Impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure. Emergencias 30:149–155
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200
Chivite D, Formiga F, Pujol R (2011) La insuficiencia cardíaca en el paciente anciano. Rev Clín Esp 211:26–35
Dharmarajan K, Hsieh AF, Lin Z, Bueno H, Ross JS, Horwitz LI et al (2013) Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA 309:355–363
Page RL 2nd, Lindenfeld J (2012) The comorbidity conundrum: a focus on the role of noncardiovascular chronic conditions in the heart failure patient. Curr Cardiol Rep 14:276–284
Trujillo-Santos AJ, Domingo-González S, Gonzalo-Blanquer J, Perea-Milla E, Jiménez-Puente A, García-Alegría J (2006) Indicadores de calidad relacionados con el reingreso y la muerte precoces tras la hospitalización por insuficiencia cardíaca. Med clín 126:165–169
Maestre A, Gil V, Gallego J, Aznar J, Mora A, Martin-Hidalgo A (2009) Diagnostic accuracy of clinical criteria for identifying systolic and diastolic heart failure: cross-sectional study. J Eval Clin Pract 15:55–61
Dodson JA, Chaudhry SI (2012) Geriatric conditions in heart failure. Curr Cardiovasc Risk Rep 6:404–410
Acknowledgements
The members of Investigators of the ICA-SEMES (Research group on Acute Heart Failure of the Spanish Society of Emergency Medicine) are 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, Carolina Xipell, Carolina Sánchez (Hospital Clínic de Barcelona), María José Pérez-Durá, Eva Salvo (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), José Manuel Torres (Hospital Reina Sofía de Córdoba), 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, Víctor Marquina, Inmaculada Jiménez, Néstor Hernández , Benjamín Brouzet, Begoña Espinosa (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 Bécquer, 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 (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 (Hospital Rey Juan Carlos de Móstoles de Madrid).
We would like to thank the Department of Medicine of the Autonomous University of Barcelona for its logistical and administrative support.
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The authors state that they have no conflict of interests with the present work. The ICA-SEMES Research Group has received unrestricted support from Orion Pharma and Novartis. The present study was designed, performed, analysed and written exclusively by the authors independently of these pharmaceutical companies.
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The original online version of this article was revised: the missing sentence are given below.
We would like to thank the Department of Medicine of the Autonomous University of Barcelona for its logistical and administrative support.
The members of ICA-SEMES Research Group is present in the Acknowledgements section.
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Rizzi, M.A., Sarasola, A.G., Arbé, A.A. et al. 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. Clin Res Cardiol 110, 993–1005 (2021). https://doi.org/10.1007/s00392-020-01710-0
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DOI: https://doi.org/10.1007/s00392-020-01710-0