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Inicio Medicina Clínica (English Edition) Mortality after an episode of acute heart failure in a cohort of patients with i...
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Vol. 151. Issue 6.
Pages 223-230 (September 2018)
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Vol. 151. Issue 6.
Pages 223-230 (September 2018)
Original article
Mortality after an episode of acute heart failure in a cohort of patients with intermediate ventricular function: Global analysis and relationship with admission department
Mortalidad tras un episodio de insuficiencia cardiaca aguda en una cohorte de pacientes con función ventricular intermedia: análisis global y en relación con el lugar de ingreso
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Òscar Miróa,b, Patricia Javaloyesc, Víctor Gila, Javier Jacobd, Pablo Herrero-Puentee, Francisco Javier Martín-Sánchezf,g, Eva Salvoh, Héctor Alonsoi, María Ángeles Juan Gómezj, John Parissisk, Pere Llorensc,l,
Corresponding author
llorens@gva.es

Corresponding author.
, on behalf of the grupo de investigación ICA-SEMES
a Grupo de investigación «Urgencias: Procesos y Patologías», Área de Urgencias, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
b Departamento de Medicina, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain
c Unidad de Corta Estancia y Hospitalización a Domicilio, Servicio de Urgencias, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)-Fundación FISABIO, Alicante, Spain
d Servicio de Urgencias, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
e Servicio de Urgencias, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (IISPA), Oviedo, Asturias, Spain
f Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
g Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
h Servicio de Urgencias, Hospital La Fe, Valencia, Spain
i Servicio de Urgencias, Hospital Marqués de Valdecilla, Santander, Spain
j Servicio de Urgencias, Hospital Doctor Peset, Valencia, Spain
k Heart Failure Unit, Department of Cardiology, Attikon University Hospital, Athens, Greece
l Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain
Cristina Gil Marta Fuentesaa, Manuel Garridoab, Pablo Garmilaac, Esther Rodríguez Adradaad, Guillermo Llopis Garciaad, Rosa Escodaae, Carolina Xipellae, Carolina Sanchezae, Josep M. Gaytanae, María José Pérez-Duráaf, José Pavónag, Antonio Novalah, José M. Torresai, María Luisa López-Grimaaj, Amparo Valeroaj, Alfons Aguirreak, Maria Àngels Pedragosaak, Maria Isabel Alonsoal, Francisco Ruizal, José Miguel Francoam, Elena Diazan, Ana Belén Mecinaao, Josep Tostap, Susana Sánchezaq, Pascual Piñeraar, Raquel Torres Garateas, Aitor Alquezarat, Miguel Alberto Rizziat, Sergio Herreraat, Irene Cabelloau, Fernando Richardav, José María Álvarez Pérezav, Maria Pilar López Diezav, Javier Lucasaw, Joaquin Vázquez Alvarezax, Marta Sánchez Gonzalezax, Jose Juan Gil Románax, Víctor Marquinaay, Inmaculada Jiménezay, Néstor Hernándezay, Ana Lópezay, Juan Antonio Anduezaaz, Rodolfo Romeroba, Roberto Calvachebb, Maria Teresa Lorcabc, Luis Calderónbc, Beatriz Amores Arriagabd, Beatriz Sierrabd, Enrique Martín Mojarrobe, Lisette Travería Bécquerbf, Lluís Llauger Garciabg, Gerard Corominas Lasallebg, Carmen Agüera Urbanobh, Ester Soy Ferrerbi
aa University Hospital of Salamanca, Spain
ab Virgen Macarena Hospital, Sevilla, Spain
ac Marqués de Valdecilla Hospital, Santander, Spain
ad San Carlos University Hospital, Madrid, Spain
ae University Hospital of Barcelona, Spain
af La Fe Hospital of Valencia, Spain
ag Dr. Negrín Hospital of Las Palmas of Gran Canaria, Spain
ah Insular Hospital of Las Palmas of Gran Canaria, Spain
ai Queen Sofia Hospital of Córdoba, Spain
aj Dr. Peset Hospital of Valencia, Spain
ak Del Mar Hospital of Barcelona, Spain
al Valme Hospital of Seville, Spain
am Miguel Servet Hospital of Zaragoza, Spain
an San Juan Hospital of Alicante, Spain
ao Hospital of Alcorcón, Spain
ap Consorci Sanitari of Terrassa, Spain
aq Río Ortega Hospital of Valladolid, Spain
ar Queen Sofia Hospital of Murcia, Spain
as Severo Ochoa Hospital, Madrid, Spain
at Santa Creu i Sant Pau Hospital of Barcelona, Spain
au Hospital Universitari de Bellvitge, Barcelona, Spain
av University Hospital of Burgos, Spain
aw General Hospital of Albacete, Spain
ax Central University Hospital of Asturias, Oviedo, Spain
ay General Hospital of Alicante, Spain
az University General Hospital Gregorio Marañón of Madrid, Spain
ba Hospital of Getafe, Madrid, Spain
bb Hospital del Henares, Coslada, Madrid, Spain
bc Hospital del Tajo, Aranjuez, Madrid, Spain
bd Lozano Blesa University Hospital of Zaragoza, Spain
be Sant Pau and Santa Tecla Hospital of Tarragona, Spain
bf University Hospital of Canarias, Tenerife, Spain
bg University Hospital of Vic, Barcelona, Spain
bh Costa del Sol Hospital of Marbella, Málaga, Spain
bi Josep Trueta Hospital of Girona, Spain
Article information
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Tables (3)
Table 1. Characteristics of patients included in the study and comparison according to the left ventricle ejection fraction group.
Table 2. Main destinations of patients with acute heart failure after Emergency Department care.
Table 3. Characteristics of patients included in the study and comparison according to destination.
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Abstract
Background and objective

To compare the outcome of patients with acute heart failure (AHF) with a mid-range left ventricular ejection fraction (HFmrEF) with patients with a reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction.

Patients and method

A prospective observational study included patients diagnosed with AHF in 41 emergency departments. Patients were divided into 3 groups: HFrEF <40%, HFmrEF 40–49% and HFpEF ≥50%. We collected 38 independent variables and the adjusted and crude all-cause mortality at one-year in the HFmrEF group was compared with that of the HFrEF and HFpEF groups. The analysis was stratified according to patient destination following ED care.

Results

Three thousand nine hundred and fifty-eight patients were included: 580 HFmrEF (14.6%), 929 HFrEF (23.5%) and 2449 HFpEF (61.9%). Global mortality at one year was 28.5%. The crude mortality of the HFmrEF group was similar to that of the HFpEF group (HR 1.009; 95% CI 0.819–1.243; p=0.933) and lower than the HFrEF group (HR 0.800; 95% CI 0.635–1.008; p=0.058), but after adjustment for discordant basal characteristics among groups, the mortality of the HFmrEF group did not differ from that of the HFpEF (HRa 1.025; 95% CI 0.825–1.275; p=0.821) or HFrEF group (HRa 0.924; 95% CI 0.720–1.186; p=0.535). Neither were significant differences found between the HFmrEF group and the other 2 groups in the analysis stratified according to admission or discharge direct from the emergency department.

Conclusion

Mortality at one-year after an AHF episode in patients with HFmrEF does not differ from that of patients with HFpEF or HfrEF, either globally or based on the main destinations after emergency department care.

Keywords:
Heart failure
Mortality
Admission
Emergency department
Mid-range left ventricular ejection fraction
Resumen
Fundamento y objetivo

Comparar la evolución tras una descompensación aguda de los pacientes con insuficiencia cardiaca (ICA) con fracción de eyección del ventrículo izquierdo intermedia (ICFEi) respecto a los que la tienen deprimida (ICFEd) o conservada (ICFEc).

Pacientes y método

Estudio observacional prospectivo, de inclusión consecutiva de pacientes diagnosticados de ICA en 41 servicios de urgencias. Se formaron 3 grupos: ICFEd<40%, ICFEi 40-49% e ICFEc50%. Se recogieron 38 variables independientes y se comparó la mortalidad por cualquier causa al año en el grupo de ICFEi, bruta y ajustada, respecto a los de ICFEd e ICFEc. Se estratificó este análisis según el destino del paciente tras la asistencia urgente.

Resultados

Se incluyeron 3.958 pacientes: 580 ICFEi (14.6%), 929 ICFEd (23.5%) y 2.449 ICFEc (61.9%). La mortalidad global al año fue del 28.5%. La mortalidad bruta en la ICFEi fue similar a la ICFEc (HR 1,009; IC 95% 0,819-1,243; p=0,933) y menor que la ICFEd (HR 0,800; IC 95% 0,635-1,008; p=0,058), pero tras el ajuste por las características basales discordantes entre grupos, la mortalidad de la ICFEi no difirió de la ICFEc (HRa 1,025; IC 95% 0,825-1,275; p=0,821) ni de la ICFEd (HRa 0,924; IC 95% 0,720-1,186; p=0,535). El análisis estratificado según el destino del ingreso o alta directa desde Urgencias tampoco mostró diferencias significativas entre la ICFEi y los otros 2 grupos.

Conclusión

La mortalidad a un año tras un episodio de ICA en pacientes con ICFEi no difiere de la de los pacientes con ICFEc o ICFEd, ni globalmente ni para ninguno de los principales destinos tras la asistencia en Urgencias.

Palabras clave:
Insuficiencia cardiaca
Mortalidad
Ingreso
Urgencias
Fracción de eyección del ventrículo izquierdo intermedia

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