Effect of precipitating factors of acute heart failure on readmission and long-term mortality.
OBJECTIVE
Acute heart failure (AHF) is one of the leading causes of unscheduled hospitalization and is associated with frequent readmissions and substantial mortality. Precipitating factors of AHF influence short-term mortality, but their effect on outcome after hospital discharge is unknown. The present study assessed the effect of precipitating factors on readmission and long-term survival in the overall population and in patients aged 75 years or younger.


RESULTS
Patients admitted with AHF (n= 755) included in the multicentre cohort 'Biomarcoeurs' were included in the study. Precipitating factors of AHF were classified in four main groups: acute coronary syndrome, atrial fibrillation, acute pulmonary disease and other causes. Hospital readmission during 90 days after discharge and survival at 1 year were analysed. Precipitating factors influenced readmissions and survival. Acute pulmonary disease was associated with fewer readmissions (HR 0.61, 95% confidence interval (CI) 0.37-0.99,P= 0.049), especially in patients aged 75 years or younger (HR 0.20, 95% CI 0.06-0.63,P= 0.006), whereas atrial fibrillation (HR 2.23, 95% CI 1.29-3.85,P= 0.004) and acute coronary syndrome (HR 2.23, 95% CI 1.02-4.86,P= 0.044) were associated with more readmissions. Patients with acute pulmonary disease at admission showed higher mortality (HR 1.59, 95% CI 1.04-2.43,P= 0.034), especially in subjects aged 75 years or younger (HR 2.52, 95% CI 1.17-5.41,P= 0.018).


CONCLUSIONS
Precipitating factors of AHF substantially influenced outcome after hospitalization. In particular, patients with AHF precipitated by acute pulmonary disease showed fewer readmissions and higher 1 year mortality, especially in patients aged 75 years or younger.
INSERM UMR-S 942 Paris France.
Mattia
0000-0003-4028-2869
M
Arrigo
INSERM UMR-S 942 Paris France.
Heli
H
Tolppanen
INSERM UMR-S 942 Paris France.
Malha
M
Sadoune
INSERM UMR-S 942 Paris France.
Elodie
E
Feliot
INSERM UMR-S 942ParisFrance; PRES Sorbonne Paris CitéUniversité Paris DiderotParisFrance; Geriatric Department, APHPSaint Louis Lariboisière University HospitalsParisFrance.
Antonio
A
Teixeira
INSERM UMR-S 942ParisFrance; PRES Sorbonne Paris CitéUniversité Paris DiderotParisFrance; Emergency Medicine Department, APHPSaint Louis Lariboisière University HospitalsParisFrance.
Said
S
Laribi
PRES Sorbonne Paris CitéUniversité Paris DiderotParisFrance; Emergency Medicine Department, APHPSaint Louis Lariboisière University HospitalsParisFrance.
Patrick
P
Plaisance
Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia.
Semir
S
Nouira
Cumhuriyet University Hospital Sivas Turkey.
Mehmet Birhan
MB
Yilmaz
INSERM UMR-S 942ParisFrance; PRES Sorbonne Paris CitéUniversité Paris DiderotParisFrance; Department of Anesthesiology and Critical Care Medicine, APHPSaint Louis Lariboisière University HospitalsParisFrance.
Etienne
E
Gayat
INSERM UMR-S 942ParisFrance; PRES Sorbonne Paris CitéUniversité Paris DiderotParisFrance; Department of Anesthesiology and Critical Care Medicine, APHPSaint Louis Lariboisière University HospitalsParisFrance.
Alexandre
A
Mebazaa
Acute heart failure; Mortality; Precipitating factor; Pulmonary disease; Readmission