title: Precipitating factors and 90-day outcome of acute heart failure: a report from the intercontinental GREAT registry.
abstract: Several clinical conditions may precipitate acute heart failure (AHF) and influence clinical outcome. In this study we hypothesized that precipitating factors are independently associated with 90-day risk of death in AHF.
  
  
  
  The study population consisted of 15 828 AHF patients from Europe and Asia. The primary outcome was 90-day all-cause mortality according to identified precipitating factors of AHF [acute coronary syndrome (ACS), infection, atrial fibrillation (AF), hypertension, and non-compliance]. Mortality at 90 days was 15.8%. AHF precipitated by ACS or by infection showed increased 90-day risk of death compared with AHF without identified precipitants [hazard ratio (HR) 1.69, 95% confidence interval (CI) 1.44-1.97, P < 0.001; and HR 1.51, 95% CI 1.18-1.92, P = 0.001), while AHF precipitated by AF showed lower 90-day risk of death (HR 0.56, 95% CI 0.42-0.75, P < 0.001), after multivariable adjustment. The risk of death in AHF precipitated by ACS was the highest during the first week after admission, while in AHF precipitated by infection the risk of death had a delayed peak at week 3. In AHF precipitated by AF, a trend toward reduced risk of death during the first weeks was shown. At weeks 5-6, AHF precipitated by ACS, infection, or AF showed similar risk of death to that of AHF without identified precipitants.
  
  
  
  Precipitating factors are independently associated with 90-day mortality in AHF. AHF precipitated by ACS or infection is independently associated with higher, while AHF precipitated by AF is associated with lower 90-day risk of death.
authors: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, and Department of Anaesthesiology and Critical Care Medicine, APHP-Saint Louis Lariboisière University Hospitals, Paris, France.|Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
authors: Mattia
authors: M
authors: Arrigo
authors: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, and Department of Anaesthesiology and Critical Care Medicine, APHP-Saint Louis Lariboisière University Hospitals, Paris, France.
authors: Etienne
authors: E
authors: Gayat
authors: Department of Cardiology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic.
authors: Jiri
authors: J
authors: Parenica
authors: Division of Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan.
authors: Shiro
authors: S
authors: Ishihara
authors: Heart Failure Center Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors: Jian
authors: J
authors: Zhang
authors: Division Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
authors: Dong-Ju
authors: DJ
authors: Choi
authors: Division Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
authors: Jin Joo
authors: JJ
authors: Park
authors: Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors: Khalid F
authors: KF
authors: Alhabib
authors: Division of Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan.
authors: Naoki
authors: N
authors: Sato
authors: Emergency Department, Hospital Clínic and 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, Barcelona, Spain.
authors: Oscar
authors: O
authors: Miro
authors: ANMCO Research Center, Florence, Italy.
authors: Aldo P
authors: AP
authors: Maggioni
authors: Heart Failure Center Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors: Yuhui
authors: Y
authors: Zhang
authors: Department of Cardiology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic.
authors: Jindrich
authors: J
authors: Spinar
authors: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, and Department of Cardiology, APHP-Lariboisière University Hospital, Paris, France.
authors: Alain
authors: A
authors: Cohen-Solal
authors: Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
authors: Theodore J
authors: TJ
authors: Iwashyna
authors: INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, and Department of Anaesthesiology and Critical Care Medicine, APHP-Saint Louis Lariboisière University Hospitals, Paris, France.
authors: Alexandre
authors: A
authors: Mebazaa
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology*; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002423:Cause of Death; D005060:Europe / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007239:Infections / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015985:Precipitating Factors; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries
keywords: Acute coronary syndrome; Acute heart failure; Atrial fibrillation; Mortality; Outcome; Precipitating factor