PMID- 33201746 OWN - NLM STAT- MEDLINE DCOM- 20210809 LR - 20210809 IS - 1502-7724 (Electronic) IS - 0281-3432 (Print) IS - 0281-3432 (Linking) VI - 38 IP - 4 DP - 2020 Dec TI - Precipitating factors of heart failure decompensation, short-term morbidity and mortality in patients attended in primary care. PG - 473-480 LID - 10.1080/02813432.2020.1844387 [doi] AB - 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. FAU - Verdu-Rotellar, Jose Maria AU - Verdu-Rotellar JM AD - Institut Catala de la Salut, Barcelona, Spain. AD - Unitat de Suport a la Recerca de Barcelona, Fundacio Institut Universitari per a la recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain. AD - School of Medicine, Universitat Autonoma de Barcelona, Bellaterra, Spain. FAU - Vaillant-Roussel, Helene AU - Vaillant-Roussel H AD - Department of General Practice, Clermont Auvergne University, Faculty of Medicine, UPU ACCePPT, Clermont-Ferrand, France. FAU - Abellana, Rosa AU - Abellana R AD - Departament de Fonaments Clinics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain. FAU - Jevsek, Lea Gril AU - Jevsek LG AD - Medical Faculty, University of Maribor, Maribor, Slovenia. FAU - Assenova, Radost AU - Assenova R AD - School of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria. FAU - Lazic, Djurdjica Kasuba AU - Lazic DK AD - Department of Family Medicine 'Andrija Stampar' School of Public Health, School of Medicine University of Zagreb, Zagreb, Croatia. FAU - Torsza, Peter AU - Torsza P AD - School of Medicine, Semmelweis University, Budapest, Hungary. FAU - Glynn, Liam George AU - Glynn LG AD - Health Research Institute and Graduate Entry Medical School, University of Limerick, Limerick, Ireland. FAU - Lingner, Heidrun AU - Lingner H AD - Hannover Medical School, Center for Public Health and Healthcare, Hannover, Germany. FAU - Demurtas, Jacopo AU - Demurtas J AD - Primary Care Department, Azienda Usl Toscana Sud Est, Grosseto, Italy. FAU - Borgstrom, Beata AU - Borgstrom B AD - Department of Clinical Sciences, Lund University, Malmo, Sweden. FAU - Gibot-Boeuf, Sylvaine AU - Gibot-Boeuf S AD - Department of General Practice, Clermont Auvergne University, Faculty of Medicine, UPU ACCePPT, Clermont-Ferrand, France. FAU - Munoz, Miguel Angel AU - Munoz MA AD - Institut Catala de la Salut, Barcelona, Spain. AD - Unitat de Suport a la Recerca de Barcelona, Fundacio Institut Universitari per a la recerca a l'Atencio Primaria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain. AD - School of Medicine, Universitat Autonoma de Barcelona, Bellaterra, Spain. LA - eng PT - Journal Article DEP - 20201117 PL - United States TA - Scand J Prim Health Care JT - Scandinavian journal of primary health care JID - 8510679 RN - 0 (Angiotensin Receptor Antagonists) RN - 0 (Angiotensin-Converting Enzyme Inhibitors) SB - IM MH - Aged, 80 and over MH - *Angiotensin Receptor Antagonists MH - Angiotensin-Converting Enzyme Inhibitors MH - Europe MH - Female MH - *Heart Failure/etiology MH - Humans MH - Male MH - Morbidity MH - Precipitating Factors MH - Primary Health Care MH - Prognosis MH - Prospective Studies MH - Stroke Volume MH - Ventricular Function, Left PMC - PMC7782727 OTO - NOTNLM OT - Heart failure OT - decompensation OT - precipitating factors OT - primary care COIS- No potential conflict of interest was reported by the author(s). EDAT- 2020/11/18 06:00 MHDA- 2021/08/10 06:00 PMCR- 2020/11/17 CRDT- 2020/11/17 17:11 PHST- 2020/11/18 06:00 [pubmed] PHST- 2021/08/10 06:00 [medline] PHST- 2020/11/17 17:11 [entrez] PHST- 2020/11/17 00:00 [pmc-release] AID - 1844387 [pii] AID - 10.1080/02813432.2020.1844387 [doi] PST - ppublish SO - Scand J Prim Health Care. 2020 Dec;38(4):473-480. doi: 10.1080/02813432.2020.1844387. Epub 2020 Nov 17.