Predictors of long-term survival in patients with a first episode of acute heart failure

Autores de INCLIVA

• 

  Julio Nuñez Villota

  Autor

• 

  Rafael De La Espriella Juan

  Autor

• Enrique Santas Olmeda

  Autor

• Gema Miñana Escriva

  Autor

Participantes ajenos a INCLIVA

• Romero-Carrete C
• Alquézar-Arbé A
• Gil V
• Jacob J
• Aguirre A
• Villarejo Jimenez A
• Borja-Cano M
• Sánchez C
• Repullo D
• Fuentes L
• Bustos SA
• Llorens P
• Miró Ò

Grupos y Plataformas de I+D+i

• Grupo de Investigación en Insuficiencia Cardiaca

  

  Established Researcher

  Julio Nuñez Villota

Abstract

Introduction: Acute heart failure (AHF) represents a critical event in heart failure progression, but data on long-term outcomes after first hospitalization remain scarce. The aim is to describe longterm survival and evaluate its predictors after the first episode of AHF. Material and methods: Patients from five Spanish hospitals with a confirmed first diagnosis of AHF were categorized based on survival (>= 5 or <5 years).Thirteen independent variables were identified. Mortality was assessed using Kaplan-Meier curves after up to 10 years of follow-up. Adjusted odds ratios (OR) with 95% confidence intervals (CI) for mortality were calculated. Additionally, adjusted survival probabilities according to patient age and left ventricular ejection fraction (LVEF) were obtained using restricted cubic splines. Results: A total of 1986 patients were included, with a median age 76 years (range: 68-82), 50% women, and 57% with preserved LVEF. Five-year mortality was 52%. Adjusted analysis showed that age (OR, 0.470 per 10-year increment; 95% CI, 0.421-0.525), New York Heart Association class III-IV vs. I (OR, 0.476; 95% CI, 0.341-0.666) and II vs. I (OR, 0.780; 95% CI, 0.627-0.969), chronic kidney disease (OR, 0.609; 95% CI, 0.452-0.820), coronary artery disease (OR, 0.657; 95% CI, 0.523-0.824), diabetes mellitus (OR, 0.658; 95% CI, 0.534-0.811), and male sex (OR, 0.774; 95% CI, 0.625-0.958) were associated with death within 5 years. LVEF at inclusion was not related to 5-year survival. Conclusions: Survival after a first AHF episode is poor, with age, NewYork Heart Association class, kidneyfunction, coronary artery disease, diabetes, and sex being key predictors of long-term mortality.

Keywords

• acute heart failure; long-term survival; mortality; outcome