title: Incidence and predictors of in-hospital non-cardiac death in patients with acute heart failure.
abstract: BACKGROUND
  Patients with acute heart failure (AHF) commonly have multiple co-morbidities, and some of these patients die in the hospital from causes other than aggravated heart failure. However, limited information is available on the mode of death in patients with AHF. Therefore, the present study was performed to determine the incidence and predictors of in-hospital non-cardiac death in patients with AHF, using the Acute Decompensated Heart Failure Syndromes (ATTEND) registry Methods: The ATTEND registry included 4842 consecutive patients with AHF admitted between April 2007-September 2011. The primary endpoint of the present study was in-hospital non-cardiac death. A stepwise regression model was used to identify the predictors of in-hospital non-cardiac death.
  
  
  RESULTS
  The incidence of all-cause in-hospital mortality was 6.4% ( n=312), and the incidence was 1.9% ( n=93) and 4.5% ( n=219) for non-cardiac and cardiac causes, respectively. Old age was associated with in-hospital non-cardiac death, with a 42% increase in the risk per decade (odds 1.42, p=0.004). Additionally, co-morbidities including chronic obstructive pulmonary disease (odds 1.98, p=0.034) and anaemia (odds 1.17 (per 1.0 g/dl decrease), p=0.006) were strongly associated with in-hospital non-cardiac death. Moreover, other predictors included low serum sodium levels (odds 1.05 (per 1.0 mEq/l decrease), p=0.045), high C-reactive protein levels (odds 1.07, p<0.001) and no statin use (odds 0.40, p=0.024).
  
  
  CONCLUSIONS
  The incidence of in-hospital non-cardiac death was markedly high in patients with AHF, accounting for 30% of all in-hospital deaths in the ATTEND registry. Thus, the prevention and management of non-cardiac complications are vital to prevent acute-phase mortality in patients with AHF, especially those with predictors of in-hospital non-cardiac death.
authors.affiliation: 1 Division of Cardiology, Showa University Fujigaoka Hospital, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakabayashi
authors.affiliation: 2 Division of Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.affiliation: 3 Division of Cardiology, Towa Hospital, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kajimoto
authors.affiliation: 4 Department of Cardiology, Tokyo Women's Medical University, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Minami
authors.affiliation: 4 Department of Cardiology, Tokyo Women's Medical University, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: 5 Department of Cardiology, Edogawa Hospital, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Keida
authors.affiliation: 6 Department of Cardiovascular Medicine, Nippon Medical School, Japan.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Asai
authors.affiliation: 7 Intensive and Cardiac Care Unit, Nippon Medical School, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Munakata
authors.affiliation: 6 Department of Cardiovascular Medicine, Nippon Medical School, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Murai
authors.affiliation: 8 Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sakata
authors.affiliation: 1 Division of Cardiology, Showa University Fujigaoka Hospital, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: 6 Department of Cardiovascular Medicine, Nippon Medical School, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Takano
mesh_terms: D000208:Acute Disease; D000368:Aged; D002423:Cause of Death / Q000639:trends; D015897:Comorbidity / Q000639:trends; D016638:Critical Illness / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends
keywords: Non-cardiac death; acute heart failure; incidence; predictors