Factors associated with in-hospital mortality and adverse outcomes during the vulnerable post-discharge phase after the
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ORIGINAL PAPER
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 Miguel Alberto Rizzi1 · Ana García Sarasola1 · Aitor Alquezar Arbé1 · Sergio Herrera Mateo1 · Víctor Gil2 · Pere Llorens3 · Javier Jacob4 · Francisco Javier Martín‑Sánchez5 · Pablo Herrero Puente6 · Rosa Escoda2 · Begoña Espinosa3 · Àlex Roset4 · Raquel Torres‑Gárate7 · José Torres‑Murillo8 · Ana B. Mecina9 · María Pilar López‑Díez10 · José María Álvarez Pérez10 · Josep Tost11 · Eva Salvo12 · María Luisa López‑Grima13 · Cristina Gil14 · María Mir15 · Frank Rutzinska14 · Ovidiu Chioncel15 · Òscar Miró2 on behalf of the ICA-SEMES Research Group Received: 18 January 2020 / Accepted: 10 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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.
Miguel Alberto Rizzi and Ana García Sarasola have contributed equally to this study. The members of ICA-SEMES Research Group is present in the Acknowledgements section.
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