title: Clinical scenario 1 is associated with winter onset of acute heart failure.
abstract: BACKGROUND
  Several reports have evaluated the association between seasonal variation and acute heart failure (AHF) onset. Cold weather may induce AHF, but the clinical characteristics of patients susceptible to AHF during winter have not been established. Clinical Scenario (CS) is used in the early clinical management of AHF, so we investigated the relationship between CS classification and winter onset of AHF in Japan.
  
  
  RESULTS
  We enrolled 582 patients hospitalized for AHF and compared the frequency of AHF among the 4 seasons in each CS group to clarify the clinical characteristics of the winter onset group. Significant increase of AHF during winter was seen in CS1 (systolic blood pressure [SBP] (>140 mmHg) (P=0.01) but not in CS2 (SBP ≥ 100 and ≤ 140 mmHg) or CS3 (SBP <100 mmHg). CS1 patients were divided into winter and other season admission groups. In multivariate analysis, only lack of loop diuretic use was associated with winter admission of CS1 patients (odds ratio 0.562, 95% confidence interval: 0.256-0.798, P=0.006).
  
  
  CONCLUSIONS
  Winter predominance of AHF was seen only in CS1, and lack of loop diuretic use was a risk factor for winter onset. Future studies are necessary to confirm whether loop diuretics are useful in preventing AHF with CS1 in winter.
authors.affiliation: Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hirai
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kato
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kinugasa
authors.forename: Shinobu
authors.initials: S
authors.lastname: Sugihara
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Kensaku
authors.initials: K
authors.lastname: Yamada
authors.forename: Tomomi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003080:Cold Temperature / Q000009:adverse effects*; D015897:Comorbidity; D019468:Disease Management; D004198:Disease Susceptibility; D004363:Drug Utilization; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013564:Sympathetic Nervous System / Q000503:physiopathology; D013599:Systole; D014661:Vasoconstriction
chemical_list: D002317:Cardiovascular Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors