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The influence of precipitating factors on short-term prognosis in acute heart failure: the PAPRICA study

Aguirre Tejedo A, Miró O, Jacob Rodríguez J, Herrero Puente P, Martín Sánchez FJ, Alemany X, Llorens Soriano P

Servicio de Urgencias, Hospital del Mar, Barcelona, Spain. √Ārea de Urgencias, Hospital Cl√≠nic, Barcelona, Spain. Grupo de Investigaci√≥n Urgencias: procesos y patolog√≠as, IDIBAPS, Barcelona, Spain, Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. √Ārea de Urgencias, Hospital Universitario Central de Asturias, Grupo de Investigaci√≥n de Urgencias-HUCA, Oviedo, Spain. Servicio de Urgencias, Hospital Cl√≠nico San Carlos, Instituto de Investigaci√≥n Sanitaria del Hospital C√≠nico San Carlos (idiSSC), Madrid, Spain. Servicio de Urgencias-UCE y Hospitalizaci√≥n a Domicilio, Hospital Universitario General de Alicante, Spain.

Background and objective: Few studies have analyzed the impact of precipitating
factors on the management of acute heart failure (AHF). The PAPRICA study sought to
explore the relationship between identifying the precipitating factor in AHF and the 30-
day mortality and emergency department revisit rates after the episode.
Methods: Retrospective, multicenter study of AHF cases with follow-up data in the
EAHFE registry (Epidemiology of Acute Heart Failure Emergencies). From the records of
AHF episodes attended in 8 Spanish emergency departments in April 2007, we extracted
the clinical characteristics of each episode and the short-term outcomes (30-day
mortality and revisits). Patients were classified by absence or presence of a known
precipitating factor for the AHF episode. Only the precipitating factor responsible for the
episode was recorded.
Results: Data for 662 cases were included. A precipitating factor was registered for
51.4% of the cases. At 30 days, overall mortality was 6.2% and revisits were made by
26.6% of the patients. The most common precipitating factors were infection (22.2%),
tachycardia (13%), hypertensive emergency (4.9%), treatment nonadherence (4.2%),
anemia (3.9%), and myocardial ischemia (3.7%). Between cases in which a precipitating
factor was identified and cases with no factor recorded in the database, we detected no
significant differences in 30-day mortality (5.0% vs 7.5%, P=.25) or revisiting rates
(29.3% vs 23.8%, P=.12). On analyzing precipitating factors individually, we noted that
a smaller percentage of patients with respiratory infections revisited within 30 days, but
there was no association with mortality. A few trends were observed for other
precipitating factors, but no differences reached statistical significance.
Conclusions: The identification of a precipitating factor was unrelated to short-term
prognosis in the PAPRICA study. However, it is possible that certain precipitating factors,
particularly respiratory infection, might be associated with different outcomes for
patients in whom no factor was identified.

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