title: Precipitating Factors for Acute Heart Failure Hospitalization and Long-Term Survival.
abstract: Heart failure (HF) patients have frequent exacerbations leading to high consumption of medical services and recurrent hospitalizations.Different precipitating factors have various effects on long-term survival.We investigated 2212 patients hospitalized with a diagnosis of either acute HF or acute exacerbation of chronic HF. Patients were divided into 2 primary precipitant groups: ischemic (N = 979 [46%]) and nonischemic (N = 1233 [54%]). The primary endpoint was all-cause mortality.Multivariate analysis demonstrated that the presence of a nonischemic precipitant was associated with a favorable in-hospital outcome (OR 0.64; CI 0.43-0.94), but with a significant increase in the risk of 10-year mortality (HR 1.12; CI 1.01-1.21). Consistently, the cumulative probability of 10-year mortality was significantly higher among patients with a nonischemic versus ischemic precipitant (83% vs 90%, respectively; Log-rank P value <0.001). Subgroup analysis showed that among the nonischemic precipitant, the presence of renal dysfunction and infection were both associated with poor short-term outcomes (OR 1.56, [P < 0.001] and OR 1.35 [P < 0.001], respectively), as well as long-term (HR 1.59 [P < 0.001] and HR 1.24 [P < 0.001], respectively).Identification of precipitating factors for acute HF hospitalization has important short- and long-term implications that can be used for improved risk stratification and management.
authors.affiliation: From the Leviev Heart Center (AB, EM, AS, FC, IG, RK); Department of Internal Medicine D (AB, EG); Pinchas Borenstein Talpiot Medical Leadership Program (EM); all at the Chaim Sheba Medical Center; Sackler School of Medicine, Tel-Aviv University (AE, IG, EG, RK); Department of Internal Medicine C, Beilinson Hospital, Rabin Medical Center (AE); and Cardiology Department, the Tel Aviv Sourasky Medical Center (YA), all are affiliated to Sackler School of Medicine, Tel-Aviv University.
authors.forename: Anat
authors.initials: A
authors.lastname: Berkovitch
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
authors.forename: Avi
authors.initials: A
authors.lastname: Sabbag
authors.forename: Fernando
authors.initials: F
authors.lastname: Chernomordik
authors.forename: Avishay
authors.initials: A
authors.lastname: Elis
authors.forename: Yaron
authors.initials: Y
authors.lastname: Arbel
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
mesh_terms: D000208:Acute Disease; D000368:Aged; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D063868:Patient Outcome Assessment; D015985:Precipitating Factors; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors