Precipitants of ADHF Affect 90-Day Outcome

Phil Vinall

doi:10.1177/155989771442008

Summary

Patients with acute decompensated heart failure are frequently treated in the emergency department prior to being admitted to the hospital. This article discusses data from the PAPRICA-2 study showing that, in almost 75% of these patients, it is possible to identify =1 precipitant of the decompensation, and these factors can be used to predict mortality risk and the probability of ED readmission.

Heart Failure Clinical Trials

Cardiology
Heart Failure
Cardiology Clinical Trials

Patients with acute decompensated heart failure (ADHF) are frequently treated in the emergency department (ED) prior to being admitted to the hospital. Òscar Miró, MD, Hospital Clínic, Barcelona, Catalonia, Spain, reported data from the PAPRICA-2 study showing that, in almost 75% of these patients, it is possible to identify ≥ 1 precipitant of the decompensation, and these factors can be used to predict mortality risk and the probability of ED readmission.

PAPRICA-2 was a retrospective study based on data from the Epidemiology of Acute Heart Failure in the Emergency Departments Registry. The study included 3535 patients (mean age, 80 years; about 58% were women) with ADHF treated in the ED and listed in the registry during 2007, 2009, and 2011 for whom a precipitating event was recorded and an outcome was available. The study end points were 90-day all-cause death and 90-day ED reconsultation for ADHF.

Most patients were NYHA functional class I or II at baseline. About 78% of all patients included in the study were admitted to the hospital. At least 1 precipitating factor was identified for 72% of patients (2562 of 3535). Multiple factors were identified in 6% (228 of 3535) of patients. Infection was the most common precipitant, followed by rapid atrial fibrillation (HR > 120 beats per minute; Table 1).

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Table 1.

Precipitating Factors Identified in PAPRICA-2

Overall 90-day mortality among the study participants was 12%. The overall rate of 90-day ED reconsultation for ADHF was 43%. Non-ST elevation acute coronary syndrome (NSTE-ACS) was associated with significantly higher 90-day mortality (P < .001). Infection was associated with a significant lower probability of 90-day ED readmission (P < .01), whereas rapid AF as a precipitant of ADHF was associated with a significantly lower probability of 90-day ED readmission and death. Anemia, hypertensive emergency, and dietetic therapeutic transgression had no significant association with 90-day outcomes.

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