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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
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
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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 FerrerbiVer más
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
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Crude and adjusted <span class="elsevierStyleItalic">Hazard ratio</span> for one-year mortality of patients with acute heart failure and moderately reduced ejection fraction compared to patients with reduced ejection fraction &#40;upper part&#41; and preserved ejection fraction &#40;lower part&#41;&#44; analysed for both the total population studied as well as according to the department to which the patient was admitted during the index episode&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">HR&#58; <span class="elsevierStyleItalic">hazard ratio</span>&#59; 95&#37; CI&#58; 95&#37; confidence interval&#59; LL&#58; lower limit of the 95&#37; confidence interval&#59; UL&#58; upper limit of the 95&#37; confidence interval&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Left ventricular ejection fraction &#40;LVEF&#41; is one of the main classifying tools for patients with heart failure &#40;HF&#41;&#46; Classically&#44; this parameter separates patients with this syndrome from those with normal or preserved LVEF &#40;&#8805;50&#37;&#41;&#44; who are identified as HF with preserved LVEF &#40;HFpEF&#41;&#44; and those that have it reduced &#40;&#60;50&#37;&#41;&#44; identified as HF with depressed LVEF &#40;HFdEF&#41;&#46; This classification allows to make important distinctions in etiological&#44; clinical&#44; therapeutic and prognostic terms&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2</span></a> However&#44; the borderline between the two categories is not entirely clear&#44; as reflected by the fact that clinical trials in HFdEF have used LVEF cut-off points below 40&#37; or even 35&#37;&#44; whereas in clinical trials of HFpEF the cut-off point has fluctuated between 40 and 50&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;4</span></a> Probably partly because of this&#44; the European Society of Cardiology has defined a new category in its latest HF guidelines&#44; called HF with intermediate LVEF &#40;HFiEF&#41;&#44; which includes patients who have an LVEF between 40 and 49&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a> However&#44; it is unknown whether this new category of HF has a differentiated course compared to the 2 classic categories &#40;HFdEF and HFpEF&#41; or if it can provide value in patients who have a decompensation event &#40;acute HF &#91;AHF&#93;&#41;&#46; Also&#44; the main destination of these patients after their Emergency Department visit is unknown&#46; It is known that&#44; in the case of HFpEF and HFdEF&#44; their distribution among the different hospitalisation options is not homogeneous&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Epidemiology of Acute Heart Failure in Emergency Departments</span> &#40;EAHFE&#41; registry is formed by a database of patients with AHF&#44; consecutively included in 41 Spanish emergency departments &#40;ED&#41;&#46; Since it contains both patients admitted to any hospital unit and those who are discharged directly from the Emergency Department&#44; it is a similar cohort to patients with AHF&#44; since most decompensated patients end up visiting an ED&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> The objective of the present study was to compare the progression of patients with HFpEF who experience an episode of AHF to patients with HFpEF and HFpEF through a secondary analysis of the EAHFE registry&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><p id="par0015" class="elsevierStylePara elsevierViewall">The EAHFE registry is a multipurpose non-interventional&#44; multicenter analytical cohort with a prospective follow-up that includes patients diagnosed with AHF in ED&#46; Five inclusion phases have been completed to date &#40;2007&#44; 2009&#44; 2011&#44; 2014 and 2016&#41;&#44; 41 ED have participated&#44; and 13&#44;793 different patients were included&#46; The systematic inclusion of patients in the EAHFE Registry and the variables collected have been extensively described in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;7</span></a> The diagnostic criteria are based on the Framingham criteria&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> along with the ESC guidelines valid at the time of patient inclusion&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">5&#44;8</span></a> and&#44; whenever possible&#44; complemented with natriuretic peptide data and echocardiographic studies performed in the Emergency Department or during the patient&#39;s admission&#46; The EAHFE Registry only excludes patients with acute myocardial infarction with ST elevation as the main diagnosis and who concomitantly develop an AHF&#44; since they follow a differentiated healthcare circuit that often avoids the Emergency Department&#46; The Registry does not include any intervention on the patient&#44; which is managed entirely at the discretion of emergency care doctors&#44; both in terms of treatment and the decision of their subsequent destination after consultation &#40;admission or home discharge&#41;&#46; The only common system among the centres is that doctors generally follow the consensus agreed between the societies of cardiology&#44; internal medicine and emergencies&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> which is distributed and commented to all emergency care doctors one week before starting the selection process&#46; The EAHFE Registry complies with the Declaration of Helsinki and all patients sign the informed consent to be part of the Registry&#46; The protocol was approved by the Clinical Research Ethics Committee of the Central University Hospital of Asturias &#40;Oviedo&#41;&#44; with protocol numbers 49&#47;2010&#44; 69&#47;2011&#44; 166&#47;13 and 160&#47;15&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study was proposed as a secondary analysis of the EAHFE registry that included patients who already had one-year follow-up at the time of the analysis &#40;patients included in phases 1&#44; 2&#44; 3 and 4 of the Registry&#44; conducted in 2007&#41;&#44; 2009&#44; 2011 and 2014&#41; and those who had an ultrasound study performed during admission or during the 6 months prior to LVEF estimation&#46; The sample was divided into 3 groups according to LVEF&#44; which was the classification variable&#58; HFdEF &#40;LVEF &#60;40&#37;&#41;&#44; HFiEF &#40;LVEF between 40 and 49&#37;&#41; and HFpEF &#40;LVEF &#8805;50&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a> On the other hand&#44; 38 independent variables that could potentially be related to the clinical progression of patients and previously agreed by the authors were collected&#58; 2 demographic &#40;age&#44; sex&#41;&#44; 12 personal history &#40;hypertension&#44; diabetes mellitus&#44; dyslipidaemia&#44; ischaemic heart disease&#44; chronic renal failure&#44; stroke&#44; atrial fibrillation&#44; peripheral arterial disease&#44; valvular heart disease&#44; chronic obstructive pulmonary disease&#44; dementia&#44; previous HF episodes&#41;&#44; 2 related to the basic functionality status &#40;Barthel index&#44; dyspnoea functional class according to the NYHA classification&#41;&#44; 5 referring to the usual chronic treatment at home &#40;diuretics&#44; angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists&#44; beta-blockers&#44; aldosterone receptor antagonist &#91;ARA&#93;&#44; digoxin&#41;&#44; 3 related to the Emergency Department condition &#40;systolic blood pressure&#44; heart rate&#44; haemoglobin&#39;s baseline arterial oxygen saturation&#41;&#44; 7 laboratory tests &#40;haematocrit&#44; estimated glomerular filtration rate&#44; sodium&#44; potassium&#44; troponin&#44; BNP and NT-proBNP&#41;&#44; 3 electrocardiographic &#40;atrial fibrillation&#44; complete left bundle-branch block and left ventricular hypertrophy&#41; and 4 of treatment in the Emergency Department &#40;use of intravenous diuretics&#44; intravenous nitro-glycerine&#44; inotropes or vasopressors and non-invasive ventilation&#41;&#46; The main outcome variable of the study was mortality from any cause at one year&#44; which was verified by telephone call to the patient and by checking both&#44; the hospital and the primary care clinical history&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The variables were expressed as absolute and relative values if they were categorical and as mean and standard deviation if they were continuous&#46; In the case of not following a normal distribution&#44; which was verified by the Kolmogorov-Smirnov test&#44; continuous variables were expressed as median and 25th and 75th percentiles&#46; A univariate study was performed to detect differences in the independent variables among the 3 groups of patients &#40;HFdEF&#44; HFiEF and HFpEF&#41; using the chi-squared test to contrast the categorical variables and an independent samples one-way ANOVA for continuous variables &#40;or the non-parametric Kruskal&#8211;Wallis test in case of non-normal distribution&#41;&#46; Kaplan&#8211;Meier survival curves truncated at one year were used for the survival analysis&#44; survival tables were prepared and the difference between curves was contrasted by the log-rank statistic&#46; Subsequently&#44; the Cox regression method was used to calculate the <span class="elsevierStyleItalic">hazard ratio</span> &#40;HR&#41; with its 95&#37; confidence interval &#40;95&#37; CI&#41; for patients with HFiEF compared to patients with HFdEF and with HFpEF&#44; both crude and adjusted for those variables that resulted in a statistically different distribution among univariate study groups&#46; The missing values were replaced by the median if the variables were continuous and by the mode if they were categorical&#44; after checking the inexistence of a loss pattern&#46; In addition&#44; the stratified survival analysis was repeated for the 4 main patient destinations once the emergency care was completed&#58; Cardiology&#44; Internal Medicine&#44; Short Stay Unit or home discharge&#46; Statistically significant differences were considered when the <span class="elsevierStyleItalic">p</span> value was less than 0&#46;05 or when the 95&#37; CI of the HR excluded the value 1&#46; IBM SPSS statistical software &#40;Armonk&#44; North Castle&#44; New York&#44; USA&#41; was used for all calculations&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">Of the 9078 patients included in the EAHFE registry in phases 1&#44; 2&#44; 3 and 4&#44; the LVEF was available in 3958 &#40;43&#46;6&#37;&#41;&#46; Of these&#44; 580 &#40;14&#46;6&#37;&#41; were classified as HFiEF &#40;mean LVEF 43 &#91;3&#37;&#93;&#41;&#44; while the rest were divided into 929 &#40;23&#46;5&#37;&#41; with HFdEF &#40;mean LVEF 29 &#91;6&#37;&#93;&#41; and 2449 &#40;61&#46;9&#37;&#41; with HFpEF &#40;mean LVEF 61&#91;8&#37;&#93;&#41;&#46; Overall&#44; the cohort includes an elderly population &#40;average age 79 years&#41;&#44; with high comorbidity&#44; and that&#44; before being treated in the ED and in a condition of clinical stability&#44; 22&#37; have some degree of functional deficit and 27&#37; of the patients had a functional class III&#8211;IV according to the NYHA classification&#46; In addition&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; the 3 groups of patients differed in 30 of the 38 variables collected&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The cumulative mortality at 30 days and at 3&#44; 6 and 12 months for the entire cohort was 8&#46;4&#44; 15&#46;5&#44; 21&#46;5 and 28&#46;5&#37;&#44; respectively&#46; Overall&#44; significant differences were observed among the 3 groups of patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#41;&#44; with a higher mortality in the HFdEF group &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; When the HFiEF group was specifically analysed&#44; it was found that these patients had a mortality very similar to that of the HFpEF group &#40;HR 1&#46;009&#44; 95&#37; CI 0&#46;819&#8211;1&#46;243&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;933&#41;&#44; and lower than that of the HFdEF group &#40;HR 0&#46;800&#44; 95&#37; CI 0&#46;635&#8211;1&#46;008&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;058&#41;&#46; When adjusting the HR for the variables that were discordant between the groups&#44; no significant differences in mortality were found for the HFpEF group compared to the HFpEF group &#40;aHR 1&#46;025&#44; 95&#37; CI 0&#46;825&#8211;1&#46;275&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;821&#41; or the HFdEF group &#40;aHR 0&#46;924&#44; 95&#37; CI 0&#46;720&#8211;1&#46;186&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;535&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The destination of patients after Emergency care is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; 23&#46;3&#37; were discharged directly from the ED without admission&#44; and the main hospitalisation services were Internal Medicine &#40;31&#46;0&#37;&#41;&#44; Cardiology &#40;20&#46;1&#37;&#41; and short-stay units &#40;12&#46;4&#37;&#41;&#46; These 4 destinations represent 86&#46;8&#37; of all patients&#46; Patients with HFdEF were admitted more frequently in Cardiology&#44; while patients with HFpEF were admitted more frequently in Geriatrics and less frequently in intensive or coronary care units&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The clinical characteristics of the patients according to the 4 most common destinations after Emergency care &#40;Internal Medicine&#44; Cardiology&#44; Short Stay or direct discharge&#41; were clearly diverse and differed in 32 of the 38 variables studied &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; as well as the cumulative mortality observed in each of them &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; When the patients&#8217; crude cumulative one-year mortality was compared according to LVEF in a stratified manner for these 4 destinations&#44; patients with HFpEF did not show differences with the other 2 groups when they enrolled in Internal Medicine&#44; Short Stay or were discharged directly from the Emergency Department&#44; while for those admitted to Cardiology had a significantly lower mortality rate than that of the patients with HFdEF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41; and similar to those who had an HFpEF &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; However&#44; when these 3 groups of patients were adjusted for clinical differences &#40;HFpEF&#44; HFiEF and HFdEF&#41;&#44; no significant differences were observed in any of the comparisons&#44; regardless of the subsequent destination after emergency care &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">This study shows that the new category of HFiEF in patients with AHF treated in ED&#58; &#40;1&#41; has intermediate clinical characteristics between the preserved and reduced group&#59; &#40;2&#41; it is not associated with a short&#44; medium and long term prognosis different to the group with preserved ejection fraction in terms of crude values&#44; and &#40;3&#41; it does not present differences in mortality compared to the other 2 groups &#40;HFdEF and HFpEF&#41; in terms of adjusted values neither in a global way nor when stratified by the admission site and is one of the few series that analyses a group of patients with AHF outside controlled studies<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;11</span></a> from the perspective of urgent care&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our series&#44; only one in 7 patients &#40;14&#46;6&#37;&#41; with AHF seen in the ED had a LVEF between 40 and 49&#37; &#40;HFiEF&#41;&#46; This group represents a small percentage of patients with AHF&#44; similar to that found in other studies performed in hospitalized patients with HF and in ambulatory patients&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a> The CHARM trial<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> showed a prevalence of 17&#37; &#40;with LVEF between 43 and 53&#37;&#41;&#44; the <span class="elsevierStyleItalic">Cardiovascular Health Study</span><a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a> was 14&#37; &#40;LVEF 45&#8211;54&#37;&#41;&#44; and the <span class="elsevierStyleItalic">Get With The Guidelines-Heart Failure</span><a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a> &#40;2005&#8211;2013&#41; database was 12&#46;8&#37; &#40;40&#8211;49&#37;&#41;&#46; In our group&#44; patients with HFpEF are mostly women of advanced age when compared to the HFdEF subgroup&#44; but similar to the HFpEF subgroup&#46; In addition&#44; they have a high prevalence of hypertension and ischaemic heart disease&#46; Regarding chronic treatment&#44; they are prescribed more beta-blockers and ARA than the HFpEF group&#46; At the Emergency Department&#44; they present with higher systolic blood pressures and lower natriuretic peptide levels than patients with HFpEF&#46; The administration of intravenous diuretics and nitro-glycerine and the use of non-invasive ventilation in ED is similar in the 3 groups&#44; and they are also admitted in similar proportions&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Clinically&#44; at the time of assessment&#44; they manifested as less advanced forms of heart disease&#44; having better NYHA functional grading and less natriuretic peptide elevations&#44; as shown in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16&#8211;18</span></a> The presence of a higher percentage of ischaemic cardiopathy in HFiEF compared to HFpEF and very similar to the HFdEF group&#44; associated with a high prevalence of arterial hypertension similar to that of patients with HFpEF&#44; has already been described&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16&#44;19</span></a> These characteristics have been used to explain the origin of this group&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> which could correspond to patients with HFdEF who have recovered or improved the LVEF over time thanks to disease-modifying therapies &#40;which would explain the higher percentage beta-blockers or ARA in this group compared to HFpEF&#41;&#44; or it could represent patients with HFpEF with a progressive LVEF worsening&#44; as evidenced in a recent study in which patients with HFpEF with ischaemic heart disease showed greater LVEF deterioration and a higher mortality during follow-up&#44; which would represent an early HFdEF stage&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> These aspects are relevant in the current discussion on whether the HFpEF and HFdEF groups are independent entities or are part of the same dynamic process&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Regarding the treatments administered in the Emergency Department&#44; no significant differences were found in the use of intravenous diuretics&#44; intravenous nitro-glycerine-type vasodilators or the use of non-invasive ventilation&#44; however&#44; administration of vasopressors or inotropic agents was more common in reduced LVEF cases&#44; perhaps related to probable episodes of low cardiac output with hypotension and hypoperfusion more commonly associated to this entity&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a> However&#44; it should be noted that unlike chronic HF&#44; where the treatments are differentiated according to HFdEF and HFpEF&#44; this therapeutic differentiation does not occur in AHF&#44; and the treatment variations that are used during acute decompensation&#44; especially in the prehospital and hospital phases of urgent care&#44; are more related to the presence of precipitating factors or clinical scenarios than with LVEF&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">21&#8211;28</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding the prognosis of HFpEF after an exacerbation&#44; it was observed that these patients&#8217; mortality was similar to that of the HFpEF and HFpEF groups when adjusting HR for the variables that were discordant&#46; We believe that this is a significant finding&#46; Different registries have analysed the prognosis in patients with HFpEF&#58; in the <span class="elsevierStyleItalic">Cardiovascular Health Study</span><a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a> the mortality was between the other 2 groups&#44; with 115 deaths per 1000 person-years&#44; compared to 154 and 87 deaths per 1000 person-years in HFdEF and HFpEF&#44; respectively&#59; in the CHARM study&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a> adjusted HR for all causes of mortality increased by 39&#37; for every 10&#37; reduction of LVEF in patients with LVEF less than 45&#37;&#59; however&#44; with LVEF greater than 45&#37;&#44; the increase in the percentage of LVEF was not associated with lower mortality&#59; thus&#44; all causes of mortality remained relatively stable despite having higher LVEF percentages&#46; Different studies with hospitalized patients describe a similar mortality in individuals with HFpEF and HFpEF&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a> In other publications that specifically study mortality in groups of patients with depressed&#44; preserved or intermediate LVEF&#44; no significant differences were observed in the follow-up at one&#44; 6&#44; and 12 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16&#44;17&#44;27&#44;28</span></a> Our study goes in this direction&#46; Although&#44; apparently&#44; our HFpEF patients&#8217; mortality was very similar to that of the HFpEF group and lower than those in the HFpEF group&#44; no significant mortality differences were found for the HFpEF group compared to HFpEF group or the HFdEF group when adjusting the HR for the discordant variables&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In addition&#44; this lack of differences in mortality at one year after a decompensation episode was observed independently of the main destinations of the patient after Emergency Department care&#44; which reinforces the value of our findings&#46; Although these destinations usually select different patient clinical profiles&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> those with HFiEF show mortality rates similar to the other groups in each of these destinations once their population differences are adjusted&#46; It is also noteworthy the fact that&#44; while there are no differences in the distribution of HFpEF after emergency care in Internal Medicine&#44; Short Stay or direct discharge without admission&#44; these patients are admitted more in Intensive Care units and less in Cardiology and Geriatrics units&#46; The objective of this study is to deepen our knowledge of this subject&#44; although we believe that the analysis of these causes will be of interest in the future&#44; since the results obtained in the different healthcare units&#44; depending on the intensity of the treatment and the general approach&#44; could be different&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Finally&#44; we found that patients admitted to Internal Medicine were older and had a higher functional deficit than those admitted to Cardiology&#44; which is in line with what has been observed in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">30&#44;31</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Our study has several limitations&#46; First&#44; the hospitals that participate in the EAHFE Registry are not chosen randomly&#44; rather&#44; they are selected because they have shown an interest in participating&#44; so there is a selection bias&#46; Second&#44; like all observational registries&#44; it does not allow firm inferences and&#44; despite the statistical adjustment made by the differences between the 3 groups&#44; it is possible that unidentified variables may have participated&#44; at least partially&#44; in the results observed in one-year survival&#46; Third&#44; the study excluded patients without documented LVEF&#44; which accounted for 54&#37; of the sample&#46; Fourth&#44; in the patients included&#44; the LVEF was determined during a 6-month variable period&#44; data which is not included in the Registry&#46; Performing an ultrasound during the stability phase after the AHF episode could have possibly improved the LVEF estimate&#44; either because it had changed from the time of performing it to the index episode &#40;if the echocardiography was performed earlier&#41; or because during that index episode&#44; in the instability phase&#44; it could have been underestimated&#46; This makes it possible for a patient to have been poorly classified&#44; although the error may have been made in both directions&#46; Finally&#44; the method used to determine LVEF was not recorded&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">However&#44; we can conclude that the study shows that patients with HFpEF have intermediate clinical characteristics between HFpEF patients and HFpEF patients&#46; However&#44; when they experience an acute decompensation&#44; their treatment in the Emergency Department does not differ significantly from that of the other 2 groups&#44; nor their subsequent mortality&#44; whether this is analysed globally or if it is evaluated according to the different patient profiles according to the main destinations after emergency care&#46; The short and long-term prognosis is similar in the 3 groups&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">The present study was made possible in part thanks to the grants PI15&#47;01019&#44; PI15&#47;00773&#44; PI11&#47;01021 and PI10&#47;01918&#44; from the Carlos III HEALTH INSTITUTE from the Ministry of Health&#44; Social Services and Equality &#40;MSSSI&#41; and the European Regional Development Fund &#40;ERDF&#41;&#59; the Generalitat de Catalunya grants for Consolidated Research Groups &#40;GRC 2009&#47;1385 and 2014&#47;0313&#41;&#59; and the Fundaci&#243; La Marat&#243; grant from TV3 &#40;2015&#47;2510&#41;&#46; The ICA-SEMES group has received unconditional grants from Orion Pharma&#44; Otsuka and Novartis Spain&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Authorship</span><p id="par0095" class="elsevierStylePara elsevierViewall">&#210;scar Mir&#243; and Patricia Javaloyes have contributed equally&#44; therefore they are both considered first author&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Fundamento y objetivo"
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    "fechaRecibido" => "2017-08-22"
    "fechaAceptado" => "2017-11-02"
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          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Heart failure"
            1 => "Mortality"
            2 => "Admission"
            3 => "Emergency department"
            4 => "Mid-range left ventricular ejection fraction"
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          "palabras" => array:5 [
            0 => "Insuficiencia cardiaca"
            1 => "Mortalidad"
            2 => "Ingreso"
            3 => "Urgencias"
            4 => "Fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo intermedia"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To compare the outcome of patients with acute heart failure &#40;AHF&#41; with a mid-range left ventricular ejection fraction &#40;HFmrEF&#41; with patients with a reduced &#40;HFrEF&#41; or preserved &#40;HFpEF&#41; left ventricular ejection fraction&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective observational study included patients diagnosed with AHF in 41 emergency departments&#46; Patients were divided into 3 groups&#58; HFrEF &#60;40&#37;&#44; HFmrEF 40&#8211;49&#37; and HFpEF &#8805;50&#37;&#46; 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&#46; The analysis was stratified according to patient destination following ED care&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Three thousand nine hundred and fifty-eight patients were included&#58; 580 HFmrEF &#40;14&#46;6&#37;&#41;&#44; 929 HFrEF &#40;23&#46;5&#37;&#41; and 2449 HFpEF &#40;61&#46;9&#37;&#41;&#46; Global mortality at one year was 28&#46;5&#37;&#46; The crude mortality of the HFmrEF group was similar to that of the HFpEF group &#40;HR 1&#46;009&#59; 95&#37; CI 0&#46;819&#8211;1&#46;243&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;933&#41; and lower than the HFrEF group &#40;HR 0&#46;800&#59; 95&#37; CI 0&#46;635&#8211;1&#46;008&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;058&#41;&#44; but after adjustment for discordant basal characteristics among groups&#44; the mortality of the HFmrEF group did not differ from that of the HFpEF &#40;HRa 1&#46;025&#59; 95&#37; CI 0&#46;825&#8211;1&#46;275&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;821&#41; or HFrEF group &#40;HRa 0&#46;924&#59; 95&#37; CI 0&#46;720&#8211;1&#46;186&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;535&#41;&#46; 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&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mortality at one-year after an AHF episode in patients with HFmrEF does not differ from that of patients with HFpEF or HfrEF&#44; either globally or based on the main destinations after emergency department care&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0005"
            "titulo" => "Background and objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and method"
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          2 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparar la evoluci&#243;n tras una descompensaci&#243;n aguda de los pacientes con insuficiencia cardiaca &#40;ICA&#41; con fracci&#243;n de eyecci&#243;n del ventr&#237;culo izquierdo intermedia &#40;ICFEi&#41; respecto a los que la tienen deprimida &#40;ICFEd&#41; o conservada &#40;ICFEc&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional prospectivo&#44; de inclusi&#243;n consecutiva de pacientes diagnosticados de ICA en 41 servicios de urgencias&#46; Se formaron 3 grupos&#58; ICFEd<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40&#37;&#44; ICFEi 40-49&#37; e ICFEc<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50&#37;&#46; Se recogieron 38 variables independientes y se compar&#243; la mortalidad por cualquier causa al a&#241;o en el grupo de ICFEi&#44; bruta y ajustada&#44; respecto a los de ICFEd e ICFEc&#46; Se estratific&#243; este an&#225;lisis seg&#250;n el destino del paciente tras la asistencia urgente&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 3&#46;958 pacientes&#58; 580 ICFEi &#40;14&#46;6&#37;&#41;&#44; 929 ICFEd &#40;23&#46;5&#37;&#41; y 2&#46;449 ICFEc &#40;61&#46;9&#37;&#41;&#46; La mortalidad global al a&#241;o fue del 28&#46;5&#37;&#46; La mortalidad bruta en la ICFEi fue similar a la ICFEc &#40;HR 1&#44;009&#59; IC 95&#37; 0&#44;819-1&#44;243&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;933&#41; y menor que la ICFEd &#40;HR 0&#44;800&#59; IC 95&#37; 0&#44;635-1&#44;008&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;058&#41;&#44; pero tras el ajuste por las caracter&#237;sticas basales discordantes entre grupos&#44; la mortalidad de la ICFEi no difiri&#243; de la ICFEc &#40;HRa 1&#44;025&#59; IC 95&#37; 0&#44;825-1&#44;275&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;821&#41; ni de la ICFEd &#40;HRa 0&#44;924&#59; IC 95&#37; 0&#44;720-1&#44;186&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;535&#41;&#46; El an&#225;lisis estratificado seg&#250;n el destino del ingreso o alta directa desde Urgencias tampoco mostr&#243; diferencias significativas entre la ICFEi y los otros 2 grupos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La mortalidad a un a&#241;o tras un episodio de ICA en pacientes con ICFEi no difiere de la de los pacientes con ICFEc o ICFEd&#44; ni globalmente ni para ninguno de los principales destinos tras la asistencia en Urgencias&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mir&#243; &#210;&#44; Javaloyes P&#44; Gil V&#44; Jacob J&#44; Herrero-Puente P&#44; Mart&#237;n-S&#225;nchez FJ&#44; et al&#46; Mortalidad tras un episodio de insuficiencia cardiaca aguda en una cohorte de pacientes con funci&#243;n ventricular intermedia&#58; an&#225;lisis global y en relaci&#243;n con el lugar de ingreso&#46; Med Clin &#40;Barc&#41;&#46; 2018&#59;151&#58;223&#8211;230&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The names of all authors of this article are listed in <a class="elsevierStyleCrossRef" href="#sec0040">Annex</a>&#46;</p>"
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            "apendice" => "<p id="par0110" class="elsevierStylePara elsevierViewall">Other researchers participating in the study of the Acute Heart Failure Working Group of the Spanish Emergency Medicine Society &#40;ICA-SEMES group&#41;&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">One-year survival according to the left ventricle ejection fraction&#46; Crude analysis &#40;left&#41; and adjusted for 30 covariates &#40;right&#41;&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HR&#58; <span class="elsevierStyleItalic">hazard ratio&#59;</span> HFpEF&#58; heart failure with preserved ejection fraction&#59; HFdEF&#58; heart failure with depressed ejection fraction&#59; HFiEF&#58; heart failure with intermediate ejection fraction&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cumulative mortality at one year after an episode of acute global heart failure and depending on the main destinations of the patient after emergency care and left ventricle ejection fraction&#46; The values of <span class="elsevierStyleItalic">p</span> &#40;not adjusted&#41; have been calculated by pairwise comparison using the log-rank test&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AHF&#58; acute heart failure&#59; HFpEF&#58; heart failure with preserved ejection fraction&#59; HFdEF&#58; heart failure with depressed ejection fraction&#59; HFiEF&#58; heart failure with intermediate ejection fraction&#46;</p>"
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        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Crude and adjusted <span class="elsevierStyleItalic">Hazard ratio</span> for one-year mortality of patients with acute heart failure and moderately reduced ejection fraction compared to patients with reduced ejection fraction &#40;upper part&#41; and preserved ejection fraction &#40;lower part&#41;&#44; analysed for both the total population studied as well as according to the department to which the patient was admitted during the index episode&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">HR&#58; <span class="elsevierStyleItalic">hazard ratio</span>&#59; 95&#37; CI&#58; 95&#37; confidence interval&#59; LL&#58; lower limit of the 95&#37; confidence interval&#59; UL&#58; upper limit of the 95&#37; confidence interval&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">ARA-II&#58; angiotensin receptor antagonist II&#59; BiPAP&#58; <span class="elsevierStyleItalic">bilevel positive airway pressure</span>&#59; BNP&#58; <span class="elsevierStyleItalic">brain natriuretic peptide</span>&#59; ARA&#58; aldosterone receptor antagonist&#59; CPAP&#58; <span class="elsevierStyleItalic">continuous positive airway pressure</span>&#59; SD&#58; standard deviation&#59; COPD&#58; chronic obstructive pulmonary disease&#59; LVEF&#58; left ventricle ejection fraction&#59; AHF&#58; acute heart failure&#59; HFpEF&#58; heart failure with preserved ejection fraction&#59; HFdEF&#58; heart failure with depressed ejection fraction&#59; HFiEF&#58; heart failure with intermediate ejection fraction&#59; ACEI&#58; angiotensin converting enzyme inhibitor&#59; NT-proBNP&#58; <span class="elsevierStyleItalic">N-terminal pro brain natriuretic peptide</span>&#59; NYHA&#58; <span class="elsevierStyleItalic">New York Heart Association&#59;</span> SBP&#58; systolic blood pressure&#59; IQR&#58; interquartile range&#59; GFR&#58; glomerular filtration rate&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3958<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HFdEF &#40;&#60;<span class="elsevierStyleHsp" style=""></span>40&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>929<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HFiEF &#40;40&#8211;49&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>580<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HFpEF &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>50&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2449<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Sociodemographic variables</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age &#40;years&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2075 &#40;52&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">315 &#40;34&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">246 &#40;42&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1514 &#40;62&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidity variables</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3401 &#40;85&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">763 &#40;82&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">491 &#40;84&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2147 &#40;87&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes Mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1815 &#40;45&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">470 &#40;50&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">284 &#40;49&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1061 &#40;43&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1917 &#40;48&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">481 &#40;51&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">287 &#40;49&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1149 &#40;46&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;037&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ischaemic heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1517 &#40;38&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">518 &#40;55&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">271 &#40;46&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">728 &#40;28&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Valvulopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1520 &#40;38&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">287 &#40;30&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">217 &#40;37&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;016 &#40;41&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3956 &#40;53&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">376 &#40;40&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">312 &#40;53&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1416 &#40;57&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chronic kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1108 &#40;28&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">284 &#40;30&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">159 &#40;27&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">665 &#40;27&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cerebrovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">548 &#40;13&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">143 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;13&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">325 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;282&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;091 &#40;27&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">254 &#40;27&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155 &#40;26&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">682 &#40;27&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;875&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peripheral arteriopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">414 &#40;10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">125 &#40;13&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">222 &#40;9&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">368 &#40;11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;10&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">260 &#40;12&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous episode of AHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2903 &#40;74&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">737 &#40;80&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">453 &#40;79&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1713 &#40;70&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Baseline condition</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NYHA III&#8211;IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">980 &#40;26&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">293 &#40;33&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118 &#40;21&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">569 &#40;25&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Barthel Index &#40;points&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;031&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Chronic treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diuretics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3035 &#40;81&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">759 &#40;84&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">443 &#40;79&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1833 &#40;79&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACEI-ARA-II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2289 &#40;61&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">590 &#40;66&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">342 &#40;61&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1357 &#40;59&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1765 &#40;47&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">527 &#40;58&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">296 &#40;53&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">942 &#40;41&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ARA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">847 &#40;22&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">300 &#40;33&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134 &#40;24&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">413 &#40;18&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Digoxin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">750 &#40;20&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180 &#40;20&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;20&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">455 &#40;19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;908&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Emergency Dpt condition</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SBP &#40;mmHg&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">133 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">141 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">143 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heart rate &#40;bpm&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oxygen saturation &#40;&#37;&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Emergency Lab tests</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Haemoglobin &#40;g&#47;l&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">119 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">123 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GFR &#40;ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;051&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sodium &#40;mmol&#47;dl&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">137 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Potassium &#40;mmol&#47;l&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;40 &#40;0&#46;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;47 &#40;0&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;42 &#40;0&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;37 &#40;0&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Increased troponin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;085 &#40;48&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">315 &#40;53&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">176 &#40;48&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">594 &#40;45&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NT-proBNP &#40;pmol&#47;l&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4381 &#40;6885&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7670 &#40;10&#44;799&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4426 &#40;7450&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3304 &#40;5277&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BNP &#40;pmol&#47;l&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">649 &#40;963&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1049 &#40;1389&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">586 &#40;797&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">498 &#40;804&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Electrocardiogram at Emergency Dpt</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">354 &#40;39&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">270 &#40;48&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1270 &#40;53&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1894 &#40;49&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Complete left bundle-branch block&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">466 &#40;12&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">199 &#40;22&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;14&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">184 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left ventricular hypertrophy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">173 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;12&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">188 &#40;8&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Emergency treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intravenous diuretics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2076 &#40;86&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">810 &#40;88&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">512 &#40;90&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2076 &#40;86&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intravenous nitro-glycerine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">723 &#40;18&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">179 &#40;19&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">424 &#40;17&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inotropes&#47;vasopressors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Non-invasive ventilation &#40;CPAP&#47;BiPAP&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">289 &#40;7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82 &#40;9&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">166 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Characteristics of patients included in the study and comparison according to the left ventricle ejection fraction group&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">HFpEF&#58; heart failure with preserved ejection fraction&#59; HFdEF&#58; heart failure with depressed ejection fraction&#59; HFiEF&#58; heart failure with intermediate ejection fraction&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Destination after emergency care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3958<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HFdEF &#40;&#60;<span class="elsevierStyleHsp" style=""></span>40&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>929<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HFiEF &#40;40&#8211;49&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>580<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HFpEF &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>50&#37;&#41;<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2449<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission to Internal Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;225 &#40;31&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">271 &#40;29&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">189 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">765 &#40;31&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;333&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission to Cardiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">794 &#40;20&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">251 &#40;27&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110 &#40;19&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">433 &#40;17&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission to Short Stay Unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">489 &#40;12&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">315 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission in Geriatrics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">233 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">169 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission to the Intensive Care Unit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;044&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission to other departments&#47;units&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">253 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">152 &#40;6&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;074&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No admission &#40;discharge from Emergency&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">923 &#40;23&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">193 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">133 &#40;23&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">597 &#40;24&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;084&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Main destinations of patients with acute heart failure after Emergency Department care&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at3"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">ARA-II&#58; angiotensin receptor antagonist II&#59; BiPAP&#58; <span class="elsevierStyleItalic">bilevel positive airway pressure</span>&#59; BNP&#58; <span class="elsevierStyleItalic">brain natriuretic peptide</span>&#59; ARA&#58; aldosterone receptor antagonist&#59; CPAP&#58; <span class="elsevierStyleItalic">continuous positive airway pressure</span>&#59; SD&#58; standard deviation&#59; COPD&#58; chronic obstructive pulmonary disease&#59; LVEF&#58; left ventricle ejection fraction&#59; AHF&#58; acute heart failure&#59; ACEI&#58; angiotensin converting enzyme inhibitor&#59; NT-proBNP&#58; <span class="elsevierStyleItalic">N-terminal pro brain natriuretic peptide</span>&#59; NYHA&#58; <span class="elsevierStyleItalic">New York Heart Association&#59;</span> SBP&#58; systolic blood pressure&#59; IQR&#58; interquartile range&#59; GFR&#58; glomerular filtration rate&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Internal Medicine<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;225<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cardiology<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>794<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Short Stay Unit<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>489<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Direct discharge from Emergency<br><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>923<br><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Sociodemographic variables</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age &#40;years&#41;&#44; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">660 &#40;54&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">365 &#40;46&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">278 &#40;56&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">469 &#40;51&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align=&