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Modes of death in heart failure according to age, sex and left ventricular ejection fraction

Internal and Emergency Medicine volume 16, pages 643–652 (2021)Cite this article

Abstract

Modes of death in patients with heart failure (HF) have been well characterized in randomized studies, but data from real-life are scarce, especially in the elderly, women and in HF with mid-range or preserved left ventricular ejection fraction (LVEF). Our purpose was to examine modes of death in HF patients according to age, sex and LVEF. We analysed the mode of death of HF patients from two prospective multicentre contemporary Spanish registries conducted by cardiologists (REDINSCOR, n = 2150) and by internists (RICA, n = 1396). Mode of death was pre-specified. Out of 3546 patients, 485 (13.7%) died during the 9-month follow-up. Cardiovascular (CV) causes were the most frequent, regardless of the age, sex and LVEF. More than half of patients died due to worsening HF in both groups of patients, followed by other non-CV causes in those attended by internists, and sudden cardiac death in those cared by cardiologists. Stroke was more common among elderly patients, women and HF with preserved LVEF. Non-CV causes, particularly infectious diseases, accounted for a remarkable proportion of deaths, especially in the elderly and in HF patients with preserved LVEF. Functional class, age and anaemia had a strong influence on both CV and non-CV death. CV death due to refractory HF was the most prevalent among our population, irrespective of age, sex or LVEF. However, a significant proportion of HF patients died from non-CV causes, particularly elderly with mid-range and preserved LVEF. These patients could benefit significantly from a multidisciplinary follow-up.

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Acknowledgements

We gratefully acknowledge all investigators who form part of the RICA and REDINSCOR Registries. This project was possible thanks to an educational unrestricted scholarship granted by Boehringer Ingelheim. We would like to thank RICA’s Registry Coordinating Center “S&H Medical Science Service” for their quality control data, logistic support, administrative work and statistical support in the preparation of the data presented in this paper.

Funding

This work was supported by grants from “Redes Temáticas de Investigación Cooperativa en Salud” del Instituto de Salud Carlos III (REDINSCOR), Madrid, Spain” [Grant no. RD06-0003-0000] and “Red de Investigación Cardiovascular del Instituto de Salud Carlos III (RIC), Madrid, Spain” [Grant no. RD12/0042/0002].

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Affiliations

  1. Internal Medicine Department, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Av. Dr. Fedriani s/n, 41009, Seville, Spain

    Prado Salamanca-Bautista, Óscar Aramburu-Bodas & José Luis Arias-Jiménez

  2. Cardiology Department, Hospital de la Santa Creu I Sant Pau, IIb-SantPau. CIBERCV, Universitat Autónoma de Barcelona, Barcelona, Spain

    Jesús Álvarez-García, Andreu Ferrero-Gregori, Miquel Vives-Borras & Juan Cinca

  3. Cardiology Department, Fundación de Investigación i+12, Hospital Universitario Doce de Octubre, CIBERCV, Facultad de Medicina UCM, Madrid, Spain

    Juan F. Delgado

  4. Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain

    Francesc Formiga

  5. Cardiology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain

    Rafael Vázquez

  6. Internal Medicine Department, Hospital Universitario Ramón y Cajal, University of Alcalá, IRYCIS, Madrid, Spain

    Luis Manzano

  7. Epidemiology and Public Health Department, Hospital de la Santa Creu I Sant Pau, II-B SantPau, Universitat Autónoma de Barcelona, Barcelona, Spain

    Teresa Puig

  8. Internal Medicine Department, Hospital de Manises, Valencia, Spain

    Pau Llàcer

  9. Internal Medicine Department, Hospital Universitario Reina Sofía, IMIBIC, University of Córdoba, Córdoba, Spain

    Manuel Montero-Pérez-Barquero

Authors
  1. Prado Salamanca-Bautista
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  2. Jesús Álvarez-García
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  3. Óscar Aramburu-Bodas
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  4. Andreu Ferrero-Gregori
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  5. José Luis Arias-Jiménez
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  6. Juan F. Delgado
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  7. Francesc Formiga
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  8. Rafael Vázquez
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  9. Luis Manzano
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  10. Teresa Puig
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  11. Pau Llàcer
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  12. Miquel Vives-Borras
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  13. Juan Cinca
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  14. Manuel Montero-Pérez-Barquero
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the REDINSCOR, RICA Investigators groups

  • Arias-Jiménez

Corresponding author

Correspondence to Prado Salamanca-Bautista.

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Both registries comply with the Declaration of Helsinki. 

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Appendix

Appendix

List of RICA and REDINSCOR investigators.

The investigators of the Spanish Heart Failure Registry (RICA): Hospital de Clínicas Dr. Manuel Quintela: Álvarez-Rocha P, Ormaechea G; Corporaciò Sanitaria Parc Taulí: Anarte L, Epelde F; Hospital Universitario Virgen Macarena: Aramburu-Bodas O, Arias-Jiménez JL, Salamanca-Bautista P; Hospital Comarcal de Zafra: Arévalo-Lorido JC; Hospital General Universitario de Valencia: Carrascosa S, García-Escrivá D, Lorente-Furió O, Pérez-Silvestre J; Complejo Hospitalario de Soria: Carrera Izquierdo M; Hospital Universitario de Getafe: Casado Cerrada J; Hospital Vega Baja: Cepeda JM; Hospital Universitario Lucus Augusti: Cerqueiro JM; Hospital Universitario de Bellvitge: Formiga F; Hospital Universitario Central de Asturias: González-Franco A; Hospital de Manises: Llàcer P; Hospital Universitario Ramón y Cajal: López-Castellanos G, Manzano L, Ruiz-Ortega R; Hospital Universitario Reina Sofía: Montero-Pérez-Barquero M; Hospital de León: Muela-Molinero A; Hospital Costa del Sol: Quirós-López R; Hospital Municipal de Badalona: Serrado-Iglesias A; Hospital Universitario Infanta Sofía: Soler-Rangel ML; Hospital Valle de Nalón: Suárez-Pedreira I; Fundació Hospital d’Olot i Comarcal de la Garrotxa: Trullàs JC.

The investigators of the Spanish Heart Failure Network (REDINSCOR): Hospital Clínic de Barcelona: J. Brugada, M. Batlle, A. Berruezo, S. Hevia, L. Mont, F. Pérez-Villa; Hospital de la Santa Creu i Sant Pau: J. Cinca, E. Roig, A. Bayés de Luna, X. Borrás, F. Carreras, A. Ferrero-Gregori, J.M. Guerra, L. Hove-Madsen, E. Jorge, R. Martínez, J. Padró, T. Puig, X. Viñolas, N. Ribas, M. Noguero, A. Mendez, J. Alvarez-Garcia, M. Vives-Borras, E. Solé-González; Hospital Clínico Universitario de Santiago de Compostela: J.R. González-Juanatey, M. Bandín, S. Eiras, L. Fernández-Hernández, J. García-Acuña, I. Gómez-Otero, L. Grigorian-Shamagian, F. Lago, P. Manzón, M. Moure, F. Otero-Raviña, F. Otero-Santiago, B. K. Rodino Janeiro, J. Rubio, A. Salgado, A. Seoane, A. Varela, P. V. Lear; Hospital Clínico San Carlos—Internal Medicine: A. Fernández-Cruz, A. Alvarez de Arcaya Vicente, M. Avila, E. Bordiu, L. Calle, C. Fernández-Pinilla, D. Gómez-Garre, L. González-Rubio, J. Marco, N. Martell, P. Muñoz-Pacheco, A. Ortega, R. Patiño, J. Pedrajas, L. Reinares; Hospital Clínico San Carlos—Cardiovascular Insitute: J. Pérez-Villacastín, R. Bover, M. Cobos, J. García-Quintanilla, J. Moreno, N. Pérez-Castellano, M. Pérez-Serrano, I. Vila; Hospital 12 de Octubre: J. F. Delgado, F. Arribas, P. Escribano, A. Flox, C. Jiménez López-Guarch, M. Paradina, J. Ruiz-Cano, C. Sáenz de la Calzada, R. Salguero, V. Sánchez-Sánchez, R. Tello de Meneses, M. Vicente-Hernández; Clínica Puerta de Hierro: L. Alonso-Pulpón, I. Fernández-Lozano, P. García-Pavía, A. García-Touchard, M. Gómez-Bueno, J. Márquez, J. Segovia, L. Silva, M. Vázquez-Mosquera; Hospital Universitario Virgen de la Arrixaca: M. Valdés, A. García-Alberola, I. Garrido, D. A. Pascual-Figal, F. J. Pastor-Pérez, J. Sánchez-Más, P. Tornel; Hospital La Fe: M. Rivera, E. Roselló-Lleti, M. Portolés, E. Tarazón, A. Ortega, M. Molina-Navarro, L. Martínez-Dolz, A. Salvador, L. Almenar; Hospital Universitario Virgen de Valme: R. Vázquez, J. Cubero, A. Fernández-Palacín, D. García-Medina, S. García-Rey, E. Laguna, J. Leal del Ojo, F. Miñano, L. Pastor-Torres, R. Pavón, A. Pérez-Navarro, D. Villagómez; Hospital Universitario Puerta del Mar: R. Vázquez, R. Arana, D. Bartolomé, P. Cabeza, G. Calle-Pérez, F. Camacho, L. Cano, A. Carrillo, E. Díaz-Retamino, V. Escolar, R. Fernández-Rivero, S. Gamaza, A. Giráldes, N. Hernández-Vicente, M. Lagares, J. López-Benítez, M. Marante, E. Otero, J. Pedregal, M. Sancho-Jaldón, R. Sevillano, R. Zayas; Gerencia del Ámbito Territorial de Bacelona-Institut Català Salud: J.M. Verdú, S. Aguilar, M. Aizpurúa, F. Alguacil, J. Casacuberta, J. Cerain, M. Domingo, M. García-Lareo, J. Herrero-Melechón, N. López-Pareja, A. Mena, A. Pérez-Orcero, J. Rodríguez-Cristóbal, M. Rozas, J. Sorribes, P. Torán; Hospital Universitario Arnau de Vilanova: F. Worner, L. Barta, C. Bravo, J. Cabau, J. Casanova, B. Daga, I. De la Puerta, I. Hernández-Martín, E. Piñol, E. Pueo, G. Torres, A. Troncoso, D. Viles; Hospital Universitario Joan XXIII: A. Bardají, J. Mercè, E. Sanz-Girgas, P. Valdovinos, I. Serrano; Hospital Universitario Virgen Macarena: O. Aramburu, J. Arias; Hospital Guadarrama: C. García-González, M. Alonso, C. Bischofberger, G. Domínguez-De Pablos; Hospital Morales Meseguer: D. Jiménez-Cervantes, I. Ureña; Hospital Son Dureta: A. Grau-Sepúlveda, C. Fiol, P. Pericas, M. Villalonga; Hospital Francesc de Borja de Gandía: P. Orosa, J. Agüero; Hospital Municipal de Badalona: F. Planas- Aymá, J. Grau-Amoros, F. Planas-Comes, L. San Vicente.

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Salamanca-Bautista, P., Álvarez-García, J., Aramburu-Bodas, Ó. et al. Modes of death in heart failure according to age, sex and left ventricular ejection fraction. Intern Emerg Med 16, 643–652 (2021). https://doi.org/10.1007/s11739-020-02468-z

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Keywords

  • Heart failure
  • Modes of death
  • Elderly
  • Women
  • Mid-range ejection fraction
  • Preserved ejection fraction