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Bezati S, Velliou M, Ventoulis I, Simitsis P, Parissis J, Polyzogopoulou E. Infection as an under-recognized precipitant of acute heart failure: prognostic and therapeutic implications. Heart Fail Rev 2023:10.1007/s10741-023-10303-8. [PMID: 36897491 PMCID: PMC9999079 DOI: 10.1007/s10741-023-10303-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/11/2023]
Abstract
As the prevalence of heart failure (HF) continues to rise, prompt diagnosis and management of various medical conditions, which may lead to HF exacerbation and result in poor patient outcomes, are of paramount importance. Infection has been identified as a common, though under-recognized, precipitating factor of acute heart failure (AHF), which can cause rapid development or deterioration of HF signs and symptoms. Available evidence indicates that infection-related hospitalizations of patients with AHF are associated with higher mortality, protracted length of stay, and increased readmission rates. Understanding the intricate interaction of both clinical entities may provide further therapeutic strategies to prevent the occurrence of cardiac complications and improve prognosis of patients with AHF triggered by infection. The purpose of this review is to investigate the incidence of infection as a causative factor in AHF, explore its prognostic implications, elucidate the underlying pathophysiological mechanisms, and highlight the basic principles of the initial diagnostic and therapeutic interventions in the emergency department.
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Affiliation(s)
- Sofia Bezati
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.
| | - Maria Velliou
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, Keptse Area, Ptolemaida, 50200, Greece
| | - Panagiotis Simitsis
- National and Kapodistrian University of Athens, 2nd Department of Cardiology, Heart Failure Unit, Attikon University Hospital, Athens, Greece
| | - John Parissis
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.,Emergency Medicine Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Effie Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.,Emergency Medicine Department, National and Kapodistrian University of Athens, Athens, Greece
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2
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Miró Ò, Ivars N, Lopez-Ayala P, Gil V, Llauger L, Alquézar-Arbé A, Jacob J, Rodríguez-Adrada E, Tost J, Mir M, Gil C, Sánchez S, Aguirre A, Martín E, Alonso MI, Garrido JM, López-Grima ML, Lucas-Imbernon FJ, Sánchez C, Escoda R, Gil A, Espinosa B, Wussler D, Peacock WF, Mueller C, Llorens P. Effect of Flu Vaccination on Severity and Outcome of Heart Failure Decompensations. J Card Fail 2023; 29:734-744. [PMID: 36706976 DOI: 10.1016/j.cardfail.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate the relationship of seasonal flu vaccination with the severity of decompensation and long-term outcomes of patients with heart failure (HF). METHODS We analyzed 6147 consecutively enrolled patients with decompensated HF who presented to 33 Spanish emergency departments (EDs) during January and February of 2018 and 2019, grouped according to seasonal flu vaccination status. The severity of HF decompensation was assessed by the Multiple Estimation of Risk Based on the Emergency Department Spanish Score in Patients With Acute Heart Failure (MEESSI-AHF) + MEESSI scale, need of hospitalization and in-hospital all-cause mortality. The long-term outcomes analyzed were 90-day postdischarge adverse events and 90-day all-cause death. Associations between vaccination, HF decompensation severity and long-term outcomes were explored by unadjusted and adjusted logistic and Cox regressions by using 14 covariables that could act as potential confounders. RESULTS Overall median (IQR) age was 84 (IQR = 77-89) years, and 56% were women. Vaccinated patients (n = 1139; 19%) were older, had more comorbidities and had worse baseline status, as assessed by New York Heart Association class and Barthel index, than did unvaccinated patients (n = 5008; 81%). Infection triggering decompensation was more common in vaccinated patients (50% vs 41%; P < 0.001). In vaccinated and unvaccinated patients, high or very-high risk decompensation was seen in 21.9% and 21.1%; hospitalization occurred in 72.5% and 73.7%; in-hospital mortality was 7.4% and 7.0%; 90-day postdischarge adverse events were 57.4% and 53.2%; and the 90-day mortality rate was 15.8% and 16.6%, respectively, with no significant differences between cohorts. After adjusting, vaccinated decompensated patients with HF had decreased odds for hospitalization (OR = 0.823, 95%CI = 0.709-0.955). CONCLUSION In patients with HF, seasonal flu vaccination is associated with less severe decompensations.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain; The GREAT network, Rome, Italy.
| | - Nicole Ivars
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Pedro Lopez-Ayala
- The GREAT network, Rome, Italy; Cardiology Department, University Hospital of Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Lluís Llauger
- Emergency Department, Hospital Universitari de Vic, Barcelona, Catalonia, Spain
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | | | - Josep Tost
- Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
| | - María Mir
- Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Cristina Gil
- Emergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Susana Sánchez
- Emergency Department, Hospital Rio Hortega, Valladolid, Spain
| | - Alfons Aguirre
- Emergency Department, Hospital del Mar, Barcelona, Catalonia, Spain
| | - Enrique Martín
- Emergency Department, Hospital Santa Tecla, Tarragona, Catalonia, Spain
| | - M Isabel Alonso
- Emergency Department, Hospital Virgen de Valme, Sevilla, Spain
| | | | | | | | - Carolina Sánchez
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Rosa Escoda
- Emergency Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Adriana Gil
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Begoña Espinosa
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Desiree Wussler
- The GREAT network, Rome, Italy; Cardiology Department, University Hospital of Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - W Frank Peacock
- The GREAT network, Rome, Italy; Emergency Department, Baylor Medical School, Houston, Texas, USA
| | - Christian Mueller
- The GREAT network, Rome, Italy; Cardiology Department, University Hospital of Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
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3
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Vasques-Nóvoa F, Pedro Ferreira J, Marques P, Sergio Neves J, Vale C, Ribeirinho-Soares P, Marques J, Martins S, Tiago Guimarães J, Barros AS, Leite-Moreira AF, Roncon-Albuquerque R, Almeida J, Bettencourt P, Friões F. Interleukin-6, infection and cardiovascular outcomes in acute heart failure: Findings from the EDIFICA registry. Cytokine 2022; 160:156053. [PMID: 36179534 DOI: 10.1016/j.cyto.2022.156053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/10/2022] [Indexed: 11/15/2022]
Abstract
AIMS Interleukin-6 (IL-6) is upregulated in response to infectious and inflammatory triggers and independently predicts all-cause mortality in acute heart failure (AHF). However, the association of IL-6 with cardiovascular outcomes and its interplay with C-reactive protein and infection, a major precipitating factor in AHF, remains poorly understood. METHODS AND RESULTS The association between IL-6 and clinical outcomes (180 days) in AHF was evaluated using a cohort of 164 patients from the EDIFICA registry. Median IL-6 levels at admission were 17.4 pg/mL. Patients in the higher admission IL-6 tertile presented with lower blood pressure and more congestion, were diagnosed more frequently with infection, and had a longer hospital stay. Higher IL-6 levels were associated with increased risk of HF rehospitalization (hazard ratio per log2 3.69, 95% confidence interval (CI) 1.26-10.8, p =.017) and the composite of HF rehospitalization or cardiovascular death (hazard ratio per log2 3.50; 95% CI 1.28-9.57; p =.014), independently of major AHF prognosticators, including B-type natriuretic peptide and renal function. However, no independent associations were found for all-cause rehospitalization or mortality. Despite a moderate correlation of IL-6 with C-reactive protein (CRP) levels (R = .51), the latter were not associated with clinical outcomes in this population. CONCLUSIONS IL-6 levels associate with higher rate of cardiovascular events in AHF, independently of classical prognosticators and evidence of infection, outperforming CRP as an inflammatory outcome biomarker.
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Affiliation(s)
- Francisco Vasques-Nóvoa
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - João Pedro Ferreira
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigations Cliniques, - Plurithématique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Pedro Marques
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Sergio Neves
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Endocrinology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Vale
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Pedro Ribeirinho-Soares
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Marques
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sandra Martins
- Department of Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - João Tiago Guimarães
- Department of Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António S Barros
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino F Leite-Moreira
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Roberto Roncon-Albuquerque
- Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Jorge Almeida
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Paulo Bettencourt
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fernando Friões
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular Research and Development Center (UnIC@RISE), Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Nagao K, Maruichi-Kawakami S, Aida K, Matsuto K, Imamoto K, Tamura A, Takazaki T, Nakatsu T, Tanaka M, Nakayama S, Morimoto T, Kimura T, Inada T. Association of peripheral venous pressure with adverse post-discharge outcomes in patients with acute heart failure: a prospective cohort study. Eur Heart J Acute Cardiovasc Care 2022; 11:407-417. [PMID: 35511694 DOI: 10.1093/ehjacc/zuac043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
AIMS Congestion is the major cause of hospitalization for heart failure (HF). Traditional bedside assessment of congestion is limited by insufficient accuracy. Peripheral venous pressure (PVP) has recently been shown to accurately predict central venous congestion. We examined the association between PVP before discharge and post-discharge outcomes in hospitalized patients with acute HF. METHODS AND RESULTS Bedside PVP measurement at the forearm vein and traditional clinical examination were performed in 239 patients. The association with the primary composite endpoint of cardiovascular death or HF hospitalization and the incremental prognostic value beyond the established HF risk score was examined. The PVP correlated with peripheral oedema, jugular venous pressure, and inferior vena cava diameter, but not with brain-type natriuretic peptide. The 1-year incidence of the primary outcome measure in the first, second, and third tertiles of PVP was 21.4, 29.9, and 40.7%, respectively (log-rank P = 0.017). The adjusted hazard ratio of PVP per 1 mmHg increase for the 1-year outcome was 1.08 [95% confidence interval (1.03-1.14), P = 0.004]. When added onto the Meta-Analysis Global Group in Chronic HF risk score, PVP significantly increased the area under the receiver-operating characteristic curve for predicting the outcome [from 0.63 (0.56-0.71) to 0.70 (0.62-0.77), P = 0.02), while traditional assessments did not. The addition of PVP also yielded significant net reclassification improvement [0.46 (0.19-0.74), P < 0.001]. CONCLUSION The PVP at discharge correlated with prognosis. The results warrant further investigation to evaluate the clinical application of PVP measurement in the care of HF. TRIAL REGISTRATION NUMBER UMIN000034279.
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Affiliation(s)
- Kazuya Nagao
- Department of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennouji-ku, 543-8555 Osaka, Japan
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, 606-8507 Kyoto, Japan
| | - Shiori Maruichi-Kawakami
- Department of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennouji-ku, 543-8555 Osaka, Japan
| | - Kenji Aida
- Department of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennouji-ku, 543-8555 Osaka, Japan
| | - Kenichi Matsuto
- Department of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennouji-ku, 543-8555 Osaka, Japan
| | - Kazumasa Imamoto
- Department of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennouji-ku, 543-8555 Osaka, Japan
| | - Akinori Tamura
- Department of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennouji-ku, 543-8555 Osaka, Japan
| | - Tadashi Takazaki
- Department of Cardiovascular Surgery, Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Taro Nakatsu
- Department of Cardiovascular Surgery, Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Masaru Tanaka
- Department of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennouji-ku, 543-8555 Osaka, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, 606-8507 Kyoto, Japan
| | - Tsukasa Inada
- Department of Cardiology, Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennouji-ku, 543-8555 Osaka, Japan
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5
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Masip J, Frank Peacok W, Arrigo M, Rossello X, Platz E, Cullen L, Mebazaa A, Price S, Bueno H, Di Somma S, Tavares M, Cowie MR, Maisel A, Mueller C, Miró Ò. Acute Heart Failure in the 2021 ESC Heart Failure Guidelines: a scientific statement from the Association for Acute CardioVascular Care (ACVC) of the European Society of Cardiology. Eur Heart J Acute Cardiovasc Care 2022; 11:173-185. [PMID: 35040931 DOI: 10.1093/ehjacc/zuab122] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 12/11/2022]
Abstract
The current European Society of Cardiology (ESC) Heart Failure Guidelines are the most comprehensive ESC document covering heart failure to date; however, the section focused on acute heart failure remains relatively too concise. Although several topics are more extensively covered than in previous versions, including some specific therapies, monitoring and disposition in the hospital, and the management of cardiogenic shock, the lack of high-quality evidence in acute, emergency, and critical care scenarios, poses a challenge for providing evidence-based recommendations, in particular when by comparison the data for chronic heart failure is so extensive. The paucity of evidence and specific recommendations for the general approach and management of acute heart failure in the emergency department is particularly relevant, because this is the setting where most acute heart failure patients are initially diagnosed and stabilized. The clinical phenotypes proposed are comprehensive, clinically relevant and with minimal overlap, whilst providing additional opportunity for discussion around respiratory failure and hypoperfusion.
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Affiliation(s)
- Josep Masip
- Research Direction, Consorci Sanitari Integral, University of Barcelona, Jacint Verdaguer 90, ES-08970 Sant Joan Despí, Barcelona, Spain
| | - W Frank Peacok
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mattia Arrigo
- Department of Internal Medicine, Stadtspital Zurich Triemli, 8063 Zurich, Switzerland.,University of Zurich, 8006 Zurich, Switzerland
| | - Xavier Rossello
- Cardiology Department, Institut d'Investigació Sanitària Illes Balears, Hospital Universitari Son Espases, Palma, Spain.,Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Faculty of Health, Queensland University of Technology and University of Queensland, Brisbane, Australia
| | - Alexandre Mebazaa
- Université de Paris, U942 Inserm MASCOT, APHP Hôpitaux Universitaires Saint Louis Lariboisière, Paris, France
| | - Susanna Price
- Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Salvatore Di Somma
- Department of Medical - Surgery Science and Translational Medicine, University of Rome Sapienza, Rome, Italy
| | - Mucio Tavares
- Emergency Department, Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | - Martin R Cowie
- Royal Brompton Hospital, Guy's & St Thomas' NHS Foundation Trust & Faculty of Lifesciences & Medicine, King's College London, London, UK
| | - Alan Maisel
- University of California, San Diego, VA, USA
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
| | - Òsar Miró
- Emergency Department, Hospital Clínic, "Processes and Pathologies, Emergencies Research Group" IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
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6
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De Matteis G, Covino M, Burzo ML, Della Polla DA, Franceschi F, Mebazaa A, Gambassi G. Clinical Characteristics and Predictors of In-Hospital Mortality among Older Patients with Acute Heart Failure. J Clin Med 2022; 11:439. [PMID: 35054133 DOI: 10.3390/jcm11020439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/17/2022] Open
Abstract
Acute Heart Failure (AHF)-related hospitalizations and mortality are still high in western countries, especially among older patients. This study aimed to describe the clinical characteristics and predictors of in-hospital mortality of older patients hospitalized with AHF. We conducted a retrospective study including all consecutive patients ≥65 years who were admitted for AHF at a single academic medical center between 1 January 2008 and 31 December 2018. The primary outcome was all-cause, in-hospital mortality. We also analyzed deaths due to cardiovascular (CV) and non-CV causes and compared early in-hospital events. The study included 6930 patients, mean age 81 years, 51% females. The overall mortality rate was 13%. Patients ≥85 years had higher mortality and early death rate than younger patients. Infections were the most common condition precipitating AHF in our cohort, and pneumonia was the most frequent of these. About half of all hospital deaths were due to non-CV causes. After adjusting for confounding factors other than NYHA class at admission, infections were associated with an almost two-fold increased risk of mortality, HR 1.74, 95% CI 1.10-2.71 in patients 65-74 years (p = 0.014); HR 1.83, 95% CI 1.34-2.49 in patients 75-84 years (p = 0.001); HR 1.74, 95% CI 1.24-2.19 in patients ≥85 years (p = 0.001). In conclusion, among older patients with AHF, in-hospital mortality rates increased with increasing age, and infections were associated with an increased risk of in-hospital mortality. In contemporary patients with AHF, along with the treatment of the CV conditions, management should be focused on timely diagnosis and appropriate treatment of non-CV factors, especially pulmonary infections.
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7
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8
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Kida K, Kitai T, Suzuki N, Ashikaga K, Kou S, Kagiyama N, Yamaguchi T, Okumura T, Mizuno A, Oishi S, Inuzuka Y, Akiyama E, Suzuki S, Yamamoto M, Matsue Y. Prognostic Implications of Reductions in Heart Rates in Patients With Acute Heart Failure and Atrial Fibrillation. Circ J 2021; 85:1869-1875. [PMID: 34248134 DOI: 10.1253/circj.cj-21-0269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhythmia in patients with acute heart failure (AHF). Heart rate (HR) also changes significantly over time. However, the association between changes in HR in AF patients and prognosis is uncertain.Methods and Results:We investigated the association between HR reduction in AF achieved within 48 h of admission and 60-day mortality in patients with AHF from the REALITY-AHF study. The percentage HR (%HR) reduction was calculated as (baseline HR-HR at 48 h) / baseline HR × 100. The primary endpoint was 60-day all-cause mortality. In 468 patients with confirmed AF at both admission and 48 h after admission, the median HR at these time points was 105±31 and 84±18 beats/min, respectively. The median %HR reduction was 15.4% (interquartile range 2.2-31.4%). During the 60 days of admission, 39 deaths (8.3%) were recorded, and the %HR reduction within 48 h was significantly associated with 60-day mortality in the unadjusted model (hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.77-0.95; P=0.005) and after adjusting for other covariates (HR 0.81; 95% CI 0.68-0.96; P=0.016).Furthermore, the %HR reduction was associated with a significant reduction in 60-day mortality in patients with higher baseline HR. CONCLUSIONS %HR reduction is associated with a better short-term prognosis in patients with AHF presenting with AF, particularly in those with a rapid ventricular response.
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Affiliation(s)
- Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Norio Suzuki
- Department of Internal Medicine, Division of Cardiology, St. Marianna University School of Medicine
| | - Kohei Ashikaga
- Department of Internal Medicine, Division of Cardiology, St. Marianna University School of Medicine
| | - Seisyou Kou
- Department of Internal Medicine, Division of Cardiology, St. Marianna University School of Medicine
| | - Nobuyuki Kagiyama
- Department of Cardiology, The Sakakibara Heart Institute of Okayama.,Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine.,Department of Digital Health and Telemedicine R&D, Juntendo University
| | - Tetsuo Yamaguchi
- Department of Cardiology, Cardiovascular Center, Toranomon Hospital
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital
| | - Shogo Oishi
- Department of Cardiology, Himeji Cardiovascular Center
| | | | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center
| | - Satoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
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9
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Rossello X, González-Del-Hoyo M. Survival analyses in cardiovascular research, part I: the essentials. ACTA ACUST UNITED AC 2021; 75:67-76. [PMID: 34215548 DOI: 10.1016/j.rec.2021.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/26/2021] [Indexed: 12/01/2022]
Abstract
This review provides a practical guide to the essentials of survival analysis and their reporting in cardiovascular studies, although most of its key content can be extrapolated to other medical fields. This is the first in a series of 2 educational articles laying the groundwork to address the most relevant statistical issues in survival analyses, which will smoothly drive the reader from the most basic analyses to the most complex situations. The focus will be on the type and shape of survival data, and the most common statistical methods, such as nonparametric, parametric and semiparametric models. Their adequacy, interpretation, advantages and disadvantages are illustrated by examples from the field of cardiovascular research. This article ends with a set of recommendations to guide the strategy of survival analyses for a randomized clinical trial and observational studies. Other topics, such as competing risks, multistate models and recurrent-event methods will be addressed in the second article.
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Affiliation(s)
- Xavier Rossello
- Servei de Cardiologia, Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma de Mallorca, Balearic Islands, Spain; Medical Statistics Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Maribel González-Del-Hoyo
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
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Miró Ò, Rossello X, Platz E, Masip J, Gualandro DM, Peacock WF, Price S, Cullen L, DiSomma S, de Oliveira MT, McMurray JJ, Martín-Sánchez FJ, Maisel AS, Vrints C, Cowie MR, Bueno H, Mebazaa A, Mueller C. Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review. Eur Heart J Acute Cardiovasc Care 2021; 9:375-398. [PMID: 33191763 DOI: 10.1177/2048872620930889] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS This study aimed to systematically identify and summarise all risk scores evaluated in the emergency department setting to stratify acute heart failure patients. METHODS AND RESULTS A systematic review of PubMed and Web of Science was conducted including all multicentre studies reporting the use of risk predictive models in emergency department acute heart failure patients. Exclusion criteria were: (a) non-original articles; (b) prognostic models without predictive purposes; and (c) risk models without consecutive patient inclusion or exclusively tested in patients admitted to a hospital ward. We identified 28 studies reporting findings on 19 scores: 13 were originally derived in the emergency department (eight exclusively using acute heart failure patients), and six in emergency department and hospitalised patients. The outcome most frequently predicted was 30-day mortality. The performance of the scores tended to be higher for outcomes occurring closer to the index acute heart failure event. The eight scores developed using acute heart failure patients only in the emergency department contained between 4-13 predictors (age, oxygen saturation and creatinine/urea included in six scores). Five scores (Emergency Heart Failure Mortality Risk Grade, Emergency Heart Failure Mortality Risk Grade 30 Day mortality ST depression, Epidemiology of Acute Heart Failure in Emergency department 3 Day, Acute Heart Failure Risk Score, and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) have been externally validated in the same country, and two (Emergency Heart Failure Mortality Risk Grade and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) further internationally validated. The c-statistic for Emergency Heart Failure Mortality Risk Grade to predict seven-day mortality was between 0.74-0.81 and for Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure to predict 30-day mortality was 0.80-0.84. CONCLUSIONS There are several scales for risk stratification of emergency department acute heart failure patients. Two of them are accurate, have been adequately validated and may be useful in clinical decision-making in the emergency department i.e. about whether to admit or discharge.
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Affiliation(s)
- Òscar Miró
- Emergency Department, University of Barcelona, Spain
| | - Xavier Rossello
- Cardiology Department, Hospital Universitari Son Espases, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.,Grupo de Fisiopatologia y Terapeutica Cardiovascular, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Elke Platz
- Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, USA
| | - Josep Masip
- Intensive Care Department, University of Barcelona, Spain.,Cardiology Department, Hospital Sanitas CIMA, Spain
| | - Danielle M Gualandro
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.,Heart Institute (INCOR), University of Sao Paulo Medical School, Brazil
| | - W Frank Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, USA
| | - Susanna Price
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College, UK
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Australia
| | - Salvatore DiSomma
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College, UK
| | | | - John Jv McMurray
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Australia
| | - Francisco J Martín-Sánchez
- Department of Emergency Medicine, Hospital Clínico San Carlos, Spain.,Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Spain
| | - Alan S Maisel
- Coronary Care Unit and Heart Failure Program, Veteran Affairs (VA) San Diego, USA
| | | | - Martin R Cowie
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College, UK
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.,Department of Cardiology and Cardiovascular Research Area, Universidad Complutense de Madrid, Spain
| | - Alexandre Mebazaa
- University Paris Diderot, France.,APHP Hôpitaux Universitaires Saint Louis Lariboisière, France
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland
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Rossello X, Bueno H, Gil V, Jacob J, Martín-Sánchez FJ, Llorens P, Herrero Puente P, Alquézar-Arbé A, Espinosa B, Raposeiras-Roubín S, Müller CE, Mebazaa A, Maggioni AP, Pocock S, Chioncel O, Miró Ò. Synergistic Impact of Systolic Blood Pressure and Perfusion Status on Mortality in Acute Heart Failure. Circ Heart Fail 2021; 14:e007347. [PMID: 33677977 DOI: 10.1161/circheartfailure.120.007347] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Physical examination remains the cornerstone in the assessment of acute heart failure. There is a lack of adequately powered studies assessing the combined impact of both systolic blood pressure (SBP) and hypoperfusion on short-term mortality. METHODS Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in 3 time periods between 2011 and 2016. Logistic regression models were used to assess the association of 30-day mortality with SBP (<90, 90-109, 110-129, and ≥130 mm Hg) and with manifestations of hypoperfusion (cold skin, cutaneous pallor, delayed capillary refill, livedo reticularis, and mental confusion) at admission. RESULTS Among 10 979 patients, 1143 died within the first 30 days (10.2%). There was an inverse association between 30-day mortality and initial SBP (35.4%, 18.9%, 12.4%, and 7.5% for SBP<90, SBP 90-109, SBP 110-129, and SBP≥130 mm Hg, respectively; P<0.001) and a positive association with hypoperfusion (8.0%, 14.8%, and 27.6% for those with none, 1, ≥2 signs/symptoms of hypoperfusion, respectively; P<0.001). After adjustment for 11 risk factors, the prognostic impact of hypoperfusion on 30-day mortality varied across SBP categories: SBP≥130 mm Hg (odds ratio [OR]=1.03 [95% CI, 0.77-1.36] and OR=1.18 [95% CI, 0.86-1.62] for 1 and ≥2 compared with 0 manifestations of hypoperfusion), SBP 110 to 129 mm Hg (OR=1.23 [95% CI, 0.86-1.77] and OR=2.18 [95% CI, 1.44-3.31], respectively), SBP 90 to 109 mm Hg (OR=1.29 [95% CI, 0.79-2.10] and OR=2.24 [95% CI, 1.36-3.66], respectively), and SBP<90 mm Hg (OR=1.34 [95% CI, 0.45-4.01] and OR=3.22 [95% CI, 1.30-7.97], respectively); P-for-interaction =0.043. CONCLUSIONS Hypoperfusion confers an incremental risk of 30-day all-cause mortality not only in patients with low SBP but also in normotensive patients. On admission, physical examination plays a major role in determining prognosis in patients with acute heart failure.
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Affiliation(s)
- Xavier Rossello
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma (X.R.).,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (X.R., H.B. S.R.-R.)
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (X.R., H.B. S.R.-R.).,Instituto de Investigación i+12, Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain (H.B.).,Facultad de Medicina (H.B.), Universidad Complutense de Madrid, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic, Barcelona (V.G., O.M.).,Emergencies: Processes and Pathologies Research Group, IDIBAPS, University of Barcelona (V.G., O.M.)
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia (J.J.)
| | - Francisco Javier Martín-Sánchez
- Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC) (F.J.M.-S.), Universidad Complutense de Madrid, Spain
| | - Pere Llorens
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante (P.L., B.E.)
| | - Pablo Herrero Puente
- Emergency Department, Hospital Universitario Central de Asturias, Oviedo (P.H.P.)
| | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia (A.A.-A.)
| | - Begoña Espinosa
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante (P.L., B.E.)
| | - Sergio Raposeiras-Roubín
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (X.R., H.B. S.R.-R.).,Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain (S.R.-R.)
| | - Christian E Müller
- Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, University of Basel, Switzerland (C.E.M.).,The GREAT (Global Research in Acute Cardiovascular Conditions Team) Network (C.E.M., A.M., O.M.)
| | - Alexandre Mebazaa
- The GREAT (Global Research in Acute Cardiovascular Conditions Team) Network (C.E.M., A.M., O.M.).,InsermU942 - MASCOT, Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, France (A.M.)
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy (A.P.M.)
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (S.P.)
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases Prof. C.C. Iliescu, Bucharest, Romania (O.C.).,University of Medicine Carol Davila, Bucharest, Romania (O.C.)
| | - Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona (V.G., O.M.).,The GREAT (Global Research in Acute Cardiovascular Conditions Team) Network (C.E.M., A.M., O.M.)
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Rossello X, Bueno H, Gil V, Jacob J, Javier Martín-Sánchez F, Llorens P, Herrero Puente P, Alquézar-Arbé A, Raposeiras-Roubín S, López-Díez MP, Pocock S, Miró Ò. MEESSI-AHF risk score performance to predict multiple post-index event and post-discharge short-term outcomes. Eur Heart J Acute Cardiovasc Care 2020; 10:142-152. [PMID: 33609116 DOI: 10.1177/2048872620934318] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The multiple estimation of risk based on the emergency department Spanish score in patients with acute heart failure (MEESSI-AHF) is a risk score designed to predict 30-day mortality in acute heart failure patients admitted to the emergency department. Using a derivation cohort, we evaluated the performance of the MEESSI-AHF risk score to predict 11 different short-term outcomes. METHODS Patients with acute heart failure from 41 Spanish emergency departments (n=7755) were recruited consecutively in two time periods (2014 and 2016). Logistic regression models based on the MEESSI-AHF risk score were used to obtain c-statistics for 11 outcomes: three with follow-up from emergency department admission (inhospital, 7-day and 30-day mortality) and eight with follow-up from discharge (7-day mortality, emergency department revisit and their combination; and 30-day mortality, hospital admission, emergency department revisit and their two combinations with mortality). RESULTS The MEESSI-AHF risk score strongly predicted mortality outcomes with follow-up starting at emergency department admission (c-statistic 0.83 for 30-day mortality; 0.82 for inhospital death, P=0.121; and 0.85 for 7-day mortality, P=0.001). Overall, mortality outcomes with follow-up starting at hospital discharge predicted slightly less well (c-statistic 0.80 for 7-day mortality, P=0.011; and 0.75 for 30-day mortality, P<0.001). In contrast, the MEESSI-AHF score predicted poorly outcomes involving emergency department revisit or hospital admission alone or combined with mortality (c-statistics 0.54 to 0.62). CONCLUSIONS The MEESSI-AHF risk score strongly predicts mortality outcomes in acute heart failure patients admitted to the emergency department, but the model performs poorly for outcomes involving hospital admission or emergency department revisit. There is a need to optimise this risk score to predict non-fatal events more effectively.
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Affiliation(s)
- Xavier Rossello
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Spain.,Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
| | - Héctor Bueno
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.,Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Víctor Gil
- Emergency Department, Hospital Clínic i Provincial de Barcelona, University of Barcelona, Spain
| | - Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, Spain
| | - Francisco Javier Martín-Sánchez
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.,Emergency Department, Hospital Clínico San Carlos, Spain.,Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Spain
| | - Pere Llorens
- Emergency Department, Hospital General de Alicante, Spain
| | | | | | - Sergio Raposeiras-Roubín
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.,Department of Cardiology, University Hospital Álvaro Cunqueiro, Spain
| | | | - Stuart Pocock
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK
| | - Òscar Miró
- Emergency Department, Hospital Clínic i Provincial de Barcelona, University of Barcelona, Spain
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