Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care

Objective: To evaluate the precipitating factors for heart failure decompensation in primary care and associations with short-term prognosis. Design Prospective cohort study with a 30-d follow-up from an index consultation. Regression models to determine independent factors associated with hospitali...

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Autores: Verdú Rotellar, Jose María, Vaillant-Roussel, Helene, Abellana Sangrà, Rosa Mari, Gril Jevsek, Lea, Assenova, Radost, Kasuba Lazic, Djurdjica, Torsza, Peter, Glynn, Liam George, Lingner, Heidrun, Demurtas, Jacopo, Borgström, Beata, Gibot-Boeuf, Sylvaine, Muñoz Pérez, Miguel Ángel
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/195423
Acceso en línea:https://hdl.handle.net/2445/195423
Access Level:acceso abierto
Palabra clave:Insuficiència cardíaca
Atenció primària
Assistència hospitalària
Morbiditat
Mortalitat
Factors de risc en les malalties
Heart failure
Primary care
Hospital care
Morbidity
Mortality
Risk factors in diseases
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spelling Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary careVerdú Rotellar, Jose MaríaVaillant-Roussel, HeleneAbellana Sangrà, Rosa MariGril Jevsek, LeaAssenova, RadostKasuba Lazic, DjurdjicaTorsza, PeterGlynn, Liam GeorgeLingner, HeidrunDemurtas, JacopoBorgström, BeataGibot-Boeuf, SylvaineMuñoz Pérez, Miguel ÁngelInsuficiència cardíacaAtenció primàriaAssistència hospitalàriaMorbiditatMortalitatFactors de risc en les malaltiesHeart failurePrimary careHospital careMorbidityMortalityRisk factors in diseasesObjective: To evaluate the precipitating factors for heart failure decompensation in primary care and associations with short-term prognosis. Design Prospective cohort study with a 30-d follow-up from an index consultation. Regression models to determine independent factors associated with hospitalisation or death. Setting: Primary care in ten European countries. Patients Patients with diagnosis of heart failure attended in primary care for a heart failure decompensation (increase of dyspnoea, unexplained weight gain or peripheral oedema). Main outcome measures: Potential precipitating factors for decompensation of heart failure and their association with the event of hospitalisation or mortality 30 d after a decompensation. Results: Of 692 patients 54% were women, mean age 81 (standard deviation [SD] 8.9) years; mean left ventricular ejection fraction (LVEF) 55% (SD 12%). Most frequently identified heart failure precipitation factors were respiratory infections in 194 patients (28%), non-compliance of dietary recommendations in 184 (27%) and non-compliance with pharmacological treatment in 157 (23%). The two strongest precipitating factors to predict 30 d hospitalisation or death were respiratory infections (odds ratio [OR] 2.8, 95% confidence interval [CI] (2.4-3.4)) and atrial fibrillation (AF) > 110 beats/min (OR 2.2, CI 1.5-3.2). Multivariate analysis confirmed the association between the following variables and hospitalisation/death: In relation to precipitating factors: respiratory infection (OR 1.19, 95% CI 1.14-1.25) and AF with heart rate > 110 beats/min (OR 1.22, 95% CI 1.10-1.35); and regarding patient characteristics: New York Heart Association (NYHA) III or IV (OR 1.22, 95% CI 1.15-1.29); previous hospitalisation (OR 1.15, 95% CI 1.11-1.19); and LVEF < 40% (OR 1.14, 95% CI 1.09-1.19). Conclusions: In primary care, respiratory infections and rapid AF are the most important precipitating factors for hospitalisation and death within 30 d following an episode of heart failure decompensation. Key points Hospitalisation due to heart failure decompensation represents the highest share of healthcare costs for this disease. So far, no primary care studies have analysed the relationship between precipitating factors and short term prognosis of heart failure decompensation episodes. We found that in 692 patients with heart failure decompensation in primary care, the respiratory infection and rapid atrial fibrillation (AF) increased the risk of short-term hospital admission or death. Patients with a hospital admission the previous year and a decompensation episode caused by respiratory infection were even more likely to be hospitalized or die within 30 d.Taylor & Francis2023202320202023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion9 p.application/pdfhttps://hdl.handle.net/2445/195423Articles publicats en revistes (Fonaments Clínics)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1080/02813432.2020.1844387Scandinavian Journal of Primary Health Care, 2020, vol. 38, num. 4, p. 473-480https://doi.org/10.1080/02813432.2020.1844387cc-by (c) Verdú Rotellar, Jose Maria et al., 2020http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1954232026-05-29T05:05:01Z
dc.title.none.fl_str_mv Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care
title Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care
spellingShingle Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care
Verdú Rotellar, Jose María
Insuficiència cardíaca
Atenció primària
Assistència hospitalària
Morbiditat
Mortalitat
Factors de risc en les malalties
Heart failure
Primary care
Hospital care
Morbidity
Mortality
Risk factors in diseases
title_short Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care
title_full Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care
title_fullStr Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care
title_full_unstemmed Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care
title_sort Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care
dc.creator.none.fl_str_mv Verdú Rotellar, Jose María
Vaillant-Roussel, Helene
Abellana Sangrà, Rosa Mari
Gril Jevsek, Lea
Assenova, Radost
Kasuba Lazic, Djurdjica
Torsza, Peter
Glynn, Liam George
Lingner, Heidrun
Demurtas, Jacopo
Borgström, Beata
Gibot-Boeuf, Sylvaine
Muñoz Pérez, Miguel Ángel
author Verdú Rotellar, Jose María
author_facet Verdú Rotellar, Jose María
Vaillant-Roussel, Helene
Abellana Sangrà, Rosa Mari
Gril Jevsek, Lea
Assenova, Radost
Kasuba Lazic, Djurdjica
Torsza, Peter
Glynn, Liam George
Lingner, Heidrun
Demurtas, Jacopo
Borgström, Beata
Gibot-Boeuf, Sylvaine
Muñoz Pérez, Miguel Ángel
author_role author
author2 Vaillant-Roussel, Helene
Abellana Sangrà, Rosa Mari
Gril Jevsek, Lea
Assenova, Radost
Kasuba Lazic, Djurdjica
Torsza, Peter
Glynn, Liam George
Lingner, Heidrun
Demurtas, Jacopo
Borgström, Beata
Gibot-Boeuf, Sylvaine
Muñoz Pérez, Miguel Ángel
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Insuficiència cardíaca
Atenció primària
Assistència hospitalària
Morbiditat
Mortalitat
Factors de risc en les malalties
Heart failure
Primary care
Hospital care
Morbidity
Mortality
Risk factors in diseases
topic Insuficiència cardíaca
Atenció primària
Assistència hospitalària
Morbiditat
Mortalitat
Factors de risc en les malalties
Heart failure
Primary care
Hospital care
Morbidity
Mortality
Risk factors in diseases
description Objective: To evaluate the precipitating factors for heart failure decompensation in primary care and associations with short-term prognosis. Design Prospective cohort study with a 30-d follow-up from an index consultation. Regression models to determine independent factors associated with hospitalisation or death. Setting: Primary care in ten European countries. Patients Patients with diagnosis of heart failure attended in primary care for a heart failure decompensation (increase of dyspnoea, unexplained weight gain or peripheral oedema). Main outcome measures: Potential precipitating factors for decompensation of heart failure and their association with the event of hospitalisation or mortality 30 d after a decompensation. Results: Of 692 patients 54% were women, mean age 81 (standard deviation [SD] 8.9) years; mean left ventricular ejection fraction (LVEF) 55% (SD 12%). Most frequently identified heart failure precipitation factors were respiratory infections in 194 patients (28%), non-compliance of dietary recommendations in 184 (27%) and non-compliance with pharmacological treatment in 157 (23%). The two strongest precipitating factors to predict 30 d hospitalisation or death were respiratory infections (odds ratio [OR] 2.8, 95% confidence interval [CI] (2.4-3.4)) and atrial fibrillation (AF) > 110 beats/min (OR 2.2, CI 1.5-3.2). Multivariate analysis confirmed the association between the following variables and hospitalisation/death: In relation to precipitating factors: respiratory infection (OR 1.19, 95% CI 1.14-1.25) and AF with heart rate > 110 beats/min (OR 1.22, 95% CI 1.10-1.35); and regarding patient characteristics: New York Heart Association (NYHA) III or IV (OR 1.22, 95% CI 1.15-1.29); previous hospitalisation (OR 1.15, 95% CI 1.11-1.19); and LVEF < 40% (OR 1.14, 95% CI 1.09-1.19). Conclusions: In primary care, respiratory infections and rapid AF are the most important precipitating factors for hospitalisation and death within 30 d following an episode of heart failure decompensation. Key points Hospitalisation due to heart failure decompensation represents the highest share of healthcare costs for this disease. So far, no primary care studies have analysed the relationship between precipitating factors and short term prognosis of heart failure decompensation episodes. We found that in 692 patients with heart failure decompensation in primary care, the respiratory infection and rapid atrial fibrillation (AF) increased the risk of short-term hospital admission or death. Patients with a hospital admission the previous year and a decompensation episode caused by respiratory infection were even more likely to be hospitalized or die within 30 d.
publishDate 2020
dc.date.none.fl_str_mv 2020
2023
2023
2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/195423
url https://hdl.handle.net/2445/195423
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1080/02813432.2020.1844387
Scandinavian Journal of Primary Health Care, 2020, vol. 38, num. 4, p. 473-480
https://doi.org/10.1080/02813432.2020.1844387
dc.rights.none.fl_str_mv cc-by (c) Verdú Rotellar, Jose Maria et al., 2020
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Verdú Rotellar, Jose Maria et al., 2020
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 9 p.
application/pdf
dc.publisher.none.fl_str_mv Taylor & Francis
publisher.none.fl_str_mv Taylor & Francis
dc.source.none.fl_str_mv Articles publicats en revistes (Fonaments Clínics)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812429

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