Precipitating factors of heart failure admission: Differences related to age and left ventricular ejection fraction.
OBJECTIVE
To evaluate precipitating factors (PF) of exacerbation in heart failure (HF) and their relationship with age, preserved vs. reduced left ventricular ejection fraction (LVEF) and short-term prognosis.


METHODS
We included and followed 2962 patients admitted with acute HF to Internal Medicine Units. Several PF were identified. Differences in PF according to preserved vs. reduced LVEF and age (patients≥80years vs. younger) were analyzed. Primary endpoints were readmission due to worsening HF and all-cause mortality at 3months follow-up. Multivariable Cox models were conducted to identify the independent predictors of 3-months mortality and readmission.


RESULTS
More than half of the patients were 80years and over, 47% were women and 61% had preserved LVEF. Atrial fibrillation (AF) and myocardial ischemia were the more common cause of decompensation among octogenarians. It was more frequent to find myocardial ischemia or non-adherence to treatment as precipitants in patients with systolic dysfunction. However, respiratory infections, AF and poor control of blood pressure were more usual in patients with preserved LVEF compared to those with LVEF <50%. Patients admitted for HF precipitated by myocardial ischemia had a higher risk of readmission at 3months (HR 1.49; CI 95%: 1.12-1.99, p=0.006) and the longest hospital stay (12days). PF showed no predictive value for mortality.


CONCLUSIONS
Myocardial ischemia as a PF was an independent marker for HF readmissions at 3-months follow-up. Precipitants are different depending on the age and LVEF of patients. Their identification could improve risk stratification and prevention strategies.
Internal Medicine Department, Hospital Universitario Virgen Macarena, Sevilla, Spain. Electronic address: pradosalamanca@gmail.com.
Prado
P
Salamanca-Bautista
Internal Medicine Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.
Alicia
A
Conde-Martel
Internal Medicine Department, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Óscar
Ó
Aramburu-Bodas
Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain.
Francesc
F
Formiga
Internal Medicine Service, Hospital d'Olot, Universitat de Girona, Spain.
Joan Carles
JC
Trullàs
Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain.
M Angustias
MA
Quesada-Simón
Internal Medicine Department, Hospital Universitario de Getafe, Madrid, Spain.
Jesús
J
Casado-Cerrada
Internal Medicine Department, Hospital Universitario Lozano Blesa, Zaragoza, Spain.
Fernando
F
Ruiz-Laiglesia
Internal Medicine Service, Hospital Universitario Ramón y Cajal - Universidad de Alcalá, Madrid, Spain.
Luis
L
Manzano
Internal Medicine Service, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain.
Manuel
M
Montero-Pérez-Barquero
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging* / Q000401:mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010343:Patient Admission / Q000639:trends*; D015985:Precipitating Factors; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*
Elderly; Heart failure; Precipitating factors