Editor’s Choice– Impact of identifying precipitating factors on 30-day mortality in acute heart failure patients
Authors: Rossello Xavier , Gil Víctor , Escoda Rosa , Jacob Javier , Aguirre Alfons , Martín-Sánchez Francisco J , Llorens Pere , Herrero Puente Pablo , Rizzi Miguel , Raposeiras-Roubín Sergio , Wussler Desiree , Müller Christian E , Gayat Etienne , Mebazaa Alexandre , Miró Òscar , Fuentes Marta , Gil Cristina , Alonso Héctor , Pérez-Llantada Enrique , Martín-Sánchez Francisco Javier , García Guillermo Llopis , Cadenas Mar Suárez , Miró Òscar , Gil Víctor , Escoda Rosa , Xipell Carolina , Sánchez Carolina , Pérez-Durá María José , Salvo Eva , Pavón José , Noval Antonio , Torres José Manuel , López-Grima María Luisa , Valero Amparo , Juan María Ángeles , Aguirre Alfons , Pedragosa Maria Àngels , Masó Silvia Mínguez , Alonso María Isabel , Ruiz Francisco , Franco José Miguel , Mecina Ana Belén , Tost Josep , Berenguer Marta , Donea Ruxandra , Ramón Susana Sánchez , Rodríguez Virginia Carbajosa , Piñera Pascual , Nicolás José Andrés Sánchez , Garate Raquel Torres , Alquézar-Arbé Aitor , Rizzi Miguel Alberto , Herrera Sergio , Jacob Javier , Roset Alex , Cabello Irene , Haro Antonio , Richard Fernando , Pérez José María Álvarez , Diez María Pilar López , Puente Pablo Herrero , Álvarez Joaquín Vázquez , García Belén Prieto , García María García , González Marta Sánchez , Llorens Pere , Javaloyes Patricia , Marquina Víctor , Jiménez Inmaculada , Hernández Néstor , Brouzet Benjamín , Espinosa Begoña , Andueza Juan Antonio , Romero Rodolfo , Ruíz Martín , Calvache Roberto , Serralta María Teresa Lorca , Jave Luis Ernesto Calderón , Arriaga Beatriz Amores , Bergua Beatriz Sierra , Mojarro Enrique Martín , Jiménez Brigitte Silvana Alarcón , Bécquer LisetteTravería , Burillo Guillermo , García Lluís Llauger , LaSalle Gerard Corominas , Urbano Carmen Agüera , Soto Ana Belén García , Padial Elisa Delgado , Ferrer Ester Soy , Garrido José Manuel , Lucas-Imbernón Francisco Javier , Gaya Rut , Bibiano Carlos , Mir María , Rodríguez Beatriz , Carballo José Luis , Rodríguez-Adrada Esther , Miranda Belén Rodríguez 
Published: August 2019

Background: The aim of this study was to describe the prevalence and prognostic value of the most common triggering factors in acute heart failure. Methods: Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in three time periods between 2011 and 2016. Precipitating factors were classified as: (a) unrecognized; (b) infection; (c) atrial fibrillation; (d) anaemia; (e) hypertension; (f) acute coronary syndrome; (g) non-adherence; and (h) two or more precipitant factors. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and each precipitant factor. The risk of dying was further evaluated by week intervals over the 30-day follow-up to assess the period of higher vulnerability for each precipitant factor. Results: Approximately 69% of our 9999 patients presented with a triggering factor and 1002 died within the first 30 days (10.0%). The most prevalent factors were infection and atrial fibrillation. After adjusting for 11 known predictors, acute coronary syndrome was associated with higher 30-day mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.02–3.42), whereas atrial fibrillation (OR 0.75; 95% CI 0.56–0.94) and hypertension (OR 0.34; 95% CI 0.21–0.55) were significantly associated with better outcomes when compared to patients without precipitant. Patients with infection, anaemia and non-compliance were not at higher risk of dying within 30 days. These findings were consistent across gender and age groups. The 30-day mortality time pattern varied between and within precipitant factors. Conclusions: Precipitant factors in acute heart failure patients are prevalent and have a prognostic value regardless of the patient’s gender and age. They can be managed with specific treatments and can sometimes be prevented.