New onset heart failure--Clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study.
BACKGROUND
Heart failure (HF) is a growing global epidemic. The main study aims is to evaluate the differences between new-onset and chronic-decompensated HF patients. Secondary objectives related only to new-onset HF patients include the role of left ventricular ejection fraction (LVEF) and mid-term mortality related risk factors


METHODS
We analyzed 2190 patients hospitalized for acute HF. We compare the 683 patients with a new-onset HF episode with the rest. Restricting the analysis to the new-onset HF patients, we also compare patients with preserved LVEF (EF>50%) with those with reduced LVEF, and analyze the factors associated with three-month mortality.


RESULTS
A total of 683 (31.2%) patients fulfill the criteria for "new-onset HF". These patients are older, their HF is more often related to hypertension, show higher blood pressure and heart rate values upon admission, and present with less global and disease-specific comorbidity and better baseline overall functional status. New-onset HF is more often characterized by preserved LVEF, milder baseline NYHA class and lower plasma natriuretic peptide values. After 3 months; 33 (5.2%) new-onset HF patients had died (p<0.001). Cox multivariate analysis showed a correlation between mortality and older age (hazard ratio - HR - 1.08), higher global comorbidity (HR 1.20) and lesser prescription of beta-blockers at discharge (HR 0.34). LVEF was unrelated to mortality.


CONCLUSIONS
New-onset HF patients show a clinical profile different to that of chronic-decompensated patients. For this subset of acute HF patients older age, higher comorbidity and beta-blocker nonprescription predict a higher risk of mid-term post-discharge mortality.
Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Jonathan
J
Franco
Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: fformiga@bellvitgehospital.cat.
Francesc
F
Formiga
Geriatric Unit, Internal Medicine Service, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
David
D
Chivite
Heart Failure and Vascular Risk Unit, Internal Medicine Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
Luis
L
Manzano
Internal Medicine Service, Complejo Hospitalario de Soria, Soria, Spain.
Margarita
M
Carrera
Internal Medicine Service, Hospital Comarcal de Zafra, Zafra, Badajoz, Spain.
José Carlos
JC
Arévalo-Lorido
Short stay Unit, Emergency Service, Hospital Universitari de Sabadell, Corporació Sanitaria Parc Tauli, Department of Medicine, UAB, Sabadell, Barcelona, Spain.
Francisco
F
Epelde
Internal Medicine Service, Hospital Lucus Augusti, Lugo Spain.
Jose Manuel
JM
Cerqueiro
Internal Medicine Service, Hospital Municipal de Badalona, Badalona, Barcelona, Spain.
Ana
A
Serrado
Internal Medicine Service, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Spain.
Manuel Montero
MM
Pérez-Barquero
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D012042:Registries; D012307:Risk Factors; D013030:Spain; D015996:Survival Rate; D016277:Ventricular Function, Left / Q000502:physiology
Chronic heart failure; Mortality; New onset heart failure