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Verdu-Rotellar JM, Vaillant-Roussel H, Abellana R, Jevsek LG, Assenova R, Lazic DK, Torsza P, Glynn LG, Lingner H, Demurtas J, Borgström B, Gibot-Boeuf S, Muñoz MA. Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care. Scand J Prim Health Care 2020; 38:473-480. [PMID: 33201746 PMCID: PMC7782727 DOI: 10.1080/02813432.2020.1844387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate the precipitating factors for heart failure decompensation in primary care and associations with short-term prognosis. Design Prospective cohort study with a 30-d follow-up from an index consultation. Regression models to determine independent factors associated with hospitalisation or death. SETTING Primary care in ten European countries. Patients Patients with diagnosis of heart failure attended in primary care for a heart failure decompensation (increase of dyspnoea, unexplained weight gain or peripheral oedema). MAIN OUTCOME MEASURES Potential precipitating factors for decompensation of heart failure and their association with the event of hospitalisation or mortality 30 d after a decompensation. RESULTS Of 692 patients 54% were women, mean age 81 (standard deviation [SD] 8.9) years; mean left ventricular ejection fraction (LVEF) 55% (SD 12%). Most frequently identified heart failure precipitation factors were respiratory infections in 194 patients (28%), non-compliance of dietary recommendations in 184 (27%) and non-compliance with pharmacological treatment in 157 (23%). The two strongest precipitating factors to predict 30 d hospitalisation or death were respiratory infections (odds ratio [OR] 2.8, 95% confidence interval [CI] (2.4-3.4)) and atrial fibrillation (AF) > 110 beats/min (OR 2.2, CI 1.5-3.2). Multivariate analysis confirmed the association between the following variables and hospitalisation/death: In relation to precipitating factors: respiratory infection (OR 1.19, 95% CI 1.14-1.25) and AF with heart rate > 110 beats/min (OR 1.22, 95% CI 1.10-1.35); and regarding patient characteristics: New York Heart Association (NYHA) III or IV (OR 1.22, 95% CI 1.15-1.29); previous hospitalisation (OR 1.15, 95% CI 1.11-1.19); and LVEF < 40% (OR 1.14, 95% CI 1.09-1.19). CONCLUSIONS In primary care, respiratory infections and rapid AF are the most important precipitating factors for hospitalisation and death within 30 d following an episode of heart failure decompensation. Key points Hospitalisation due to heart failure decompensation represents the highest share of healthcare costs for this disease. So far, no primary care studies have analysed the relationship between precipitating factors and short term prognosis of heart failure decompensation episodes. We found that in 692 patients with heart failure decompensation in primary care, the respiratory infection and rapid atrial fibrillation (AF) increased the risk of short-term hospital admission or death. Patients with a hospital admission the previous year and a decompensation episode caused by respiratory infection were even more likely to be hospitalized or die within 30 d.
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Affiliation(s)
- José María Verdu-Rotellar
- Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
- CONTACT José María Verdu-Rotellar Departament de Salut, Unitat de Suport a la Recerca, Gerència Territorial de Barcelona, Institut Català de la Salut-IDIAP Jordi Gol, | Generalitat de Catalunya Carrer Sardenya, 375 Entlo, Barcelona08025, Spain
| | - Helene Vaillant-Roussel
- Department of General Practice, Clermont Auvergne University, Faculty of Medicine, UPU ACCePPT, Clermont-Ferrand, France
| | - Rosa Abellana
- Departament de Fonaments Clinics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | - Radost Assenova
- School of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Djurdjica Kasuba Lazic
- Department of Family Medicine ‘Andrija Stampar’ School of Public Health, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Peter Torsza
- School of Medicine, Semmelweis University, Budapest, Hungary
| | - Liam George Glynn
- Health Research Institute and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Heidrun Lingner
- Hannover Medical School, Center for Public Health and Healthcare, Hannover, Germany
| | - Jacopo Demurtas
- Primary Care Department, Azienda Usl Toscana Sud Est, Grosseto, Italy
| | - Beata Borgström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Sylvaine Gibot-Boeuf
- Department of General Practice, Clermont Auvergne University, Faculty of Medicine, UPU ACCePPT, Clermont-Ferrand, France
| | - Miguel Angel Muñoz
- Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca de Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Miró Ò, Aguirre A, Herrero P, Jacob J, Martín-Sánchez FJ, Llorens P. [PAPRICA-2 study: Role of precipitating factor of an acute heart failure episode on intermediate term prognosis]. Med Clin (Barc) 2015; 145:385-9. [PMID: 25817454 DOI: 10.1016/j.medcli.2015.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the precipitating factors (PF) associated with acute heart failure and their association with medium-term prognosis. PATIENTS AND METHODS Multipurpose prospective study from the EAHFE Registry. We included as PF: infection, rapid atrial fibrillation (RAF), anaemia, hypertensive crisis, non-adherence to diet or drug therapy and non-ST-segment-elevation acute coronary syndrome (NSTEACS). Patients without PF were control group. Hazard ratios (HR) crudes and adjusted for reconsultations and mortality at 90 days were calculated. RESULTS 3535 patients were included: 28% without and 72% with PF. Patients with RAF (HR 0.67; 95%CI 0.50-0.89) and hypertensive crisis (HR 0.45; 95%CI 0.28-0.72) had less mortality and patients with NSTEACS (HR 1.79; 95%CI 1.19-2.70) had more mortality. Reconsultation was fewer in patients with infection (HR 0.74; 95%CI 0.64-0.85), RAF (HR 0.69; 95%CI 0.58-0.83) and hypertensive crisis (HR 0.71; 95%CI 0.55-0.91). These differences were maintained in all the adjusted models except for hypertensive crisis. CONCLUSIONS One PF is identified in 3 out of 4 patients and it may influence medium-term prognosis. At 90 days, NSTEACS and RAF were associated with more and less mortality respectively, and RAF and infection with less probability of reconsultation.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona. Grupo de investigación «Urgencias: Procesos y Patologías», IDIBAPS, Barcelona, España.
| | - Alfons Aguirre
- Servicio de Urgencias, Hospital del Mar, Barcelona, España
| | - Pablo Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, España
| | - Pere Llorens
- Servicio de Urgencias Departamentales, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital General de Alicante, Alicante, España
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Maltais S, Joggerst SJ, Hatzopoulos A, DiSalvo TG, Zhao D, Sung HJ, Wang X, Byrne JG, Naftilan AJ. Stem cell therapy for chronic heart failure: an updated appraisal. Expert Opin Biol Ther 2013; 13:503-16. [PMID: 23289619 DOI: 10.1517/14712598.2013.749852] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Significant advances have been made to understand the mechanisms involved in cardiac cell-based therapies. The early translational application of basic science knowledge has led to several animal and human clinical trials. The initial promising beneficial effect of stem cells on cardiac function restoration has been eclipsed by the inability of animal studies to translate into sustained clinical improvements in human clinical trials. AREAS COVERED In this review, the authors cover an updated overview of various stem cell populations used in chronic heart failure. A critical review of clinical trials conducted in advanced heart failure patients is proposed, and finally promising avenues for developments in the field of cardiac cell-based therapies are presented. EXPERT OPINION Several questions remain unanswered, and this limits our ability to understand basic mechanisms involved in stem cell therapeutics. Human studies have revealed critical unresolved issues. Further elucidation of the proper timing, mode delivery and prosurvival factors is imperative, if the field is to advance. The limited benefits seen to date are simply not enough if the potential for substantial recovery of nonfunctioning myocardium is to be realized.
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