PMID- 32588981 OWN - NLM STAT- MEDLINE DCOM- 20210621 LR - 20210621 IS - 2055-5822 (Electronic) IS - 2055-5822 (Linking) VI - 7 IP - 5 DP - 2020 Oct TI - In-hospital and long-term mortality for acute heart failure: analysis at the time of admission to the emergency department. PG - 2650-2661 LID - 10.1002/ehf2.12847 [doi] AB - AIMS: Acute heart failure (AHF) leads to a drastic increase in mortality and rehospitalization. The aim of the study was to identify prognostic variables in a real-life population of AHF patients admitted to the emergency department with acute shortness of breath. METHODS AND RESULTS: We evaluated potential predictors of mortality in 728 consecutive patients admitted to the emergency department with AHF. Possible predictors of all-cause and cardiovascular (CV) mortality were investigated by Cox and Fine and Gray models at multivariable analysis. Among the 728 patients, 256 died during the entire follow-up, 142 of these due to CV cause. The 1 year mortality rate was 20%, with the highest risk of death during the index hospitalization (with 8% estimate in-hospital mortality at 30 days). A higher risk of events during the index hospitalization was more evident for the CV deaths, for which we found a cumulative 1 year incidence of 12% with a cumulative incidence in the first 30 days of hospitalization of about 5%. At multivariable analysis, age (P < 0.001), New York Heart Association (NYHA) class IV vs. I-II-III (P = 0.001), systolic blood pressure (P < 0.001), non-cardiac co-morbidities (>/=3 vs. 0, P = 0.05), oxygen saturation (P = 0.03), serum creatinine (P < 0.001), and left ventricular ejection fraction (LVEF) (40-49% vs. <40%, P = 0.004; >/=50% vs. <40%, P = 0.003) were independent predictors of all-cause mortality during the entire follow-up. Age (P = 0.03), systolic blood pressure (P = 0.01), oxygen saturation (P = 0.03), serum creatinine (P = 0.02), and LVEF (40-49% vs. <40%, P = 0.03; >/=50% vs. <40%, P = 0.004) were independent predictors of CV mortality during the entire follow-up. NYHA class IV vs. I-II-III (P < 0.001), serum creatinine (P = 0.01), and LVEF (40-49% vs. <40%, P = 0.02; >/=50% vs. <40%, P < 0.001) remained independent predictors for in-hospital death, while only serum creatinine (P = 0.04), LVEF (40-49% vs. <40%: 0.32, P = 0.04; >/=50% vs. <40%, P < 0.001), and NYHA class vs. I-II-III (P = 0.02) remained predictors for in-hospital CV mortality. CONCLUSIONS: In this real-life cohort of patients with AHF, the results showed a similar mortality rate comparing with other analysis and with the most important registries. Age, NYHA class IV, systolic blood pressure, creatinine levels, sodium levels, and ejection fraction were independent predictors of 1 year mortality, while LVEF <40% was the only predictor of both all-cause mortality and CV mortality. CI - (c) 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. FAU - Lombardi, Carlo AU - Lombardi C AD - Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, University of Brescia Spedali Civili of Brescia, Brescia, Italy. FAU - Peveri, Giulia AU - Peveri G AD - Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy. FAU - Cani, Dario AU - Cani D AD - Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, University of Brescia Spedali Civili of Brescia, Brescia, Italy. FAU - Latta, Federica AU - Latta F AD - Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, University of Brescia Spedali Civili of Brescia, Brescia, Italy. FAU - Bonelli, Andrea AU - Bonelli A AD - Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, University of Brescia Spedali Civili of Brescia, Brescia, Italy. FAU - Tomasoni, Daniela AU - Tomasoni D AD - Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, University of Brescia Spedali Civili of Brescia, Brescia, Italy. FAU - Sbolli, Marco AU - Sbolli M AD - Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, University of Brescia Spedali Civili of Brescia, Brescia, Italy. FAU - Ravera, Alice AU - Ravera A AD - Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, University of Brescia Spedali Civili of Brescia, Brescia, Italy. FAU - Carubelli, Valentina AU - Carubelli V AD - Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, University of Brescia Spedali Civili of Brescia, Brescia, Italy. FAU - Saccani, Nicola AU - Saccani N AD - Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, University of Brescia Spedali Civili of Brescia, Brescia, Italy. FAU - Specchia, Claudia AU - Specchia C AD - Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy. FAU - Metra, Marco AU - Metra M AD - Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, University of Brescia Spedali Civili of Brescia, Brescia, Italy. LA - eng PT - Journal Article DEP - 20200626 PL - England TA - ESC Heart Fail JT - ESC heart failure JID - 101669191 SB - IM MH - Emergency Service, Hospital MH - *Heart Failure MH - Hospital Mortality MH - Hospitalization MH - Hospitals MH - Humans MH - Stroke Volume MH - *Ventricular Function, Left PMC - PMC7524058 OTO - NOTNLM OT - Acute heart failure OT - Creatinine OT - Ejection fraction OT - Mortality predictors OT - NYHA class COIS- The authors have no conflict of interest in regard to this manuscript. EDAT- 2020/06/27 06:00 MHDA- 2021/06/22 06:00 PMCR- 2020/06/26 CRDT- 2020/06/27 06:00 PHST- 2019/11/03 00:00 [received] PHST- 2020/05/28 00:00 [revised] PHST- 2020/06/02 00:00 [accepted] PHST- 2020/06/27 06:00 [pubmed] PHST- 2021/06/22 06:00 [medline] PHST- 2020/06/27 06:00 [entrez] PHST- 2020/06/26 00:00 [pmc-release] AID - EHF212847 [pii] AID - 10.1002/ehf2.12847 [doi] PST - ppublish SO - ESC Heart Fail. 2020 Oct;7(5):2650-2661. doi: 10.1002/ehf2.12847. Epub 2020 Jun 26.