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array:24 [ "pii" => "S2387020616001789" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.03.002" "estado" => "S300" "fechaPublicacion" => "2015-11-06" "aid" => "3234" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2015;145:385-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775315000731" "issn" => "00257753" "doi" => "10.1016/j.medcli.2015.01.014" "estado" => "S300" "fechaPublicacion" => "2015-11-06" "aid" => "3234" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2015;145:385-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 19 "formatos" => array:2 [ "HTML" => 7 "PDF" => 12 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>" "titulo" => "Estudio PAPRICA-2: papel del factor precipitante del episodio de insuficiencia cardiaca aguda en el pronóstico a medio plazo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "385" "paginaFinal" => "389" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "PAPRICA-2 study: Role of precipitating factor of an acute heart failure episode on intermediate term prognosis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2299 "Ancho" => 3562 "Tamanyo" => 618584 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Izquierda: curvas de supervivencia acumulada a 90 días para la reconsulta a urgencias (superior) y la mortalidad (inferior) en función de la presencia de factores precipitantes del episodio de insuficiencia cardiaca aguda. Derecha: riesgos proporcionales crudos y ajustados para las curvas de supervivencia de reconsulta a urgencias (arriba) y mortalidad (abajo) a 90 días para aquellos factores precipitantes del episodio de insuficiencia cardiaca aguda que resultaron estadísticamente significativos en el estudio univariado. Modelo A: incluye en el ajuste factores epidemiológicos (edad y sexo). Modelo B: incluye en el ajuste factores epidemiológicos (edad y sexo) y del estado basal del paciente (clase funcional de la NYHA e índice de Barthel). Modelo C: incluye en el ajuste factores epidemiológicos (edad y sexo), del estado basal del paciente (clase funcional de la NYHA e índice de Barthel) y del episodio actual de insuficiencia cardiaca aguda (presión arterial sistólica, saturación arterial basal de oxígeno, creatinina y sodio). Modelo D: incluye en el ajuste factores epidemiológicos (edad y sexo), del estado basal del paciente (clase funcional de la NYHA e índice de Barthel), del episodio actual de insuficiencia cardiaca aguda (presión arterial sistólica, saturación arterial basal de oxígeno, creatinina y sodio) y de disposición final del paciente (ingreso hospitalario o alta directa desde urgencias).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Òscar Miró, Alfons Aguirre, Pablo Herrero, Javier Jacob, Francisco Javier Martín-Sánchez, Pere Llorens" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Òscar" "apellidos" => "Miró" ] 1 => array:2 [ "nombre" => "Alfons" "apellidos" => "Aguirre" ] 2 => array:2 [ "nombre" => "Pablo" "apellidos" => "Herrero" ] 3 => array:2 [ "nombre" => "Javier" "apellidos" => "Jacob" ] 4 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Martín-Sánchez" ] 5 => array:2 [ "nombre" => "Pere" "apellidos" => "Llorens" ] 6 => array:1 [ "colaborador" => "en nombre del grupo ICA-SEMES" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020616001789" "doi" => "10.1016/j.medcle.2016.03.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616001789?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315000731?idApp=UINPBA00004N" "url" => "/00257753/0000014500000009/v1_201510150221/S0025775315000731/v1_201510150221/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020616001790" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.03.003" "estado" => "S300" "fechaPublicacion" => "2015-11-06" "aid" => "3331" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2015;145:390-1" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>" "titulo" => "Innovation in health" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "390" "paginaFinal" => "391" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La innovación en salud" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jose J. Navas Palacios" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Jose J." "apellidos" => "Navas Palacios" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315003036" "doi" => "10.1016/j.medcli.2015.05.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315003036?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616001790?idApp=UINPBA00004N" "url" => "/23870206/0000014500000009/v2_201605020201/S2387020616001790/v2_201605020201/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020616001777" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.03.001" "estado" => "S300" "fechaPublicacion" => "2015-11-06" "aid" => "3158" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2015;145:380-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Effects of an exercise and relaxation aquatic program in patients with spondyloarthritis: A randomized trial" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "380" "paginaFinal" => "384" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectos de un programa de ejercicio físico y relajación en el medio acuático en pacientes con espondiloartritis: ensayo clínico aleatorizado" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2145 "Ancho" => 2480 "Tamanyo" => 275159 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Design and flow of patients in the clinical trial. NSAIDs: nonsteroidal antiinflammatory drugs; ESSG: <span class="elsevierStyleItalic">European Spondylarthropathy Study Group</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rubén Fernández García, Laura de Carmen Sánchez Sánchez, María del Mar López Rodríguez, Gema Sánchez Granados" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Rubén" "apellidos" => "Fernández García" ] 1 => array:2 [ "nombre" => "Laura de Carmen" "apellidos" => "Sánchez Sánchez" ] 2 => array:2 [ "nombre" => "María del Mar" "apellidos" => "López Rodríguez" ] 3 => array:2 [ "nombre" => "Gema" "apellidos" => "Sánchez Granados" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775314008070" "doi" => "10.1016/j.medcli.2014.10.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775314008070?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616001777?idApp=UINPBA00004N" "url" => "/23870206/0000014500000009/v2_201605020201/S2387020616001777/v2_201605020201/en/main.assets" ] "en" => array:22 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "PAPRICA-2 study: Role of precipitating factor of an acute heart failure episode on intermediate term prognosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "385" "paginaFinal" => "389" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Òscar Miró, Alfons Aguirre, Pablo Herrero, Javier Jacob, Francisco Javier Martín-Sánchez, Pere Llorens" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Òscar" "apellidos" => "Miró" "email" => array:1 [ 0 => "omiro@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Alfons" "apellidos" => "Aguirre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Pablo" "apellidos" => "Herrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Javier" "apellidos" => "Jacob" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Martín-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Pere" "apellidos" => "Llorens" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:2 [ "colaborador" => "on behalf of the ICA-SEMES group" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Área de Urgencias, Hospital Clínic, Barcelona, Grupo de investigación «Urgencias: Procesos y Patologías», IDIBAPS, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital del Mar, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Urgencias Departamentales, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio PAPRICA-2: papel del factor precipitante del episodio de insuficiencia cardiaca aguda en el pronóstico a medio plazo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2297 "Ancho" => 3557 "Tamanyo" => 590757 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Left: cumulative survival curves within 90 days for revisits to the emergency department (above) and mortality (below) depending on the presence of precipitating factors of acute episode of heart failure. Right: crude and adjusted hazard ratios for survival curves of revisits to the emergency room (above) and mortality (below) within 90 days for those precipitating factors of acute episode of heart failure statistically significant in the univariate analysis. Model A: epidemiological factors are included in adjustment (age and sex). Model B: epidemiological (age and sex) and baseline patient condition (NYHA functional class and Barthel index) factors are included in the adjustment. Model C: epidemiological (age and sex), baseline patient condition (functional NYHA class and Barthel index) and the current episode of acute heart failure (systolic blood pressure, blood saturation basal oxygen, creatinine and sodium) factors are included in the adjustment. Model D: epidemiological (age and sex), baseline patient condition (functional NYHA class and Barthel index), the current episode of acute heart failure (systolic blood pressure, baseline arterial oxygen saturation, creatinine and sodium) and final destination of the patient (hospital admission or discharge directly from the emergency department) factors are included in the adjustment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acute heart failure (AHF) is the leading cause of medical consultation and hospitalization in emergency departments (EDs). AHF episodes may be triggered by a well defined set of precipitating factors (PFs). There are few studies assessing these factors, and even fewer studies have researched their impact on prognosis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> On the study of Prognosis role of precipitating factors of an acute episode of heart failure (PAPRICA), an association between PF and mortality within 30 days was not evident and only the infection was associated with a lower rate of revisits within 30 days.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> It was estimated that a relatively short follow-up (30 days) and a limited sample size (662 cases) may have influenced the results. Therefore, this study was planned in order to evaluate the frequency of PFs and their possible association with the medium-term AHF prognosis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methodology</span><p id="par0010" class="elsevierStylePara elsevierViewall">PAPRICA-2 is a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments Registry (EAHFE) with the participation of 29 Spanish EDs collecting consecutively all patients diagnosed with AHF based on clinical criteria, except for those with an acute coronary syndrome (ACS) and elevated ST occurring simultaneously.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The participants of this study were the patients were the “PF of AHF episode” variable was verified. This variable could be encoded as “absence of PF identified” or “existence of PF”, and in the latter case 6 PFs were regarded: “Infection” if fever and infection criteria prior to or simultaneously with episode of AHF; “Rapid atrial fibrillation (AF)” if frequency >120<span class="elsevierStyleHsp" style=""></span>per minute and treatment was required; “Anemia” if hemoglobin <10<span class="elsevierStyleHsp" style=""></span>g/dl; “Hypertensive emergency” if the initial systolic blood pressure was >160<span class="elsevierStyleHsp" style=""></span>mmHg and vasodilator treatment was required; “Non adherence to therapy or diet” in case of discontinuation of treatment or diet; and “non-ST elevation ACS” (NSTEACS, based on the criteria of the European Society of Cardiology), if the episode occurred simultaneously. Each patient could present more than one PF, which were assigned according to the judgment of the clinician attending the patient. In these cases, the patient was included repeatedly in the individual analysis of each of the PF presented.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The independent variables were age, sex, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, valvular heart disease, cerebrovascular disease, peripheral artery disease, permanent AF, chronic renal failure (creatinine<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mg/dL), previous episodes of AHF, NYHA functional class and Barthel index, systolic blood pressure, heart rate, respiratory rate, baseline arterial oxygen saturation, serum hemoglobin, creatinine, sodium and potassium, and final destination of the patient (admission or discharge from emergencies). The variables of this study were the revisits to the emergency department for new episodes of AHF and all-cause mortality, which were checked by reviewing the medical history and/or telephone contact. The protocol was approved by the Ethics Committee of each center and patients signed an informed consent.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Quantitative variables were expressed as mean and standard deviation and qualitative variables as absolute values and ratios. Kaplan–Meier survival tables were built and truncated at 90 days and groups with PF were compared to those without identified PF by log-rank test. The differences were expressed as hazard ratios (HR) with 95% confidence interval (95% CI). Various progressive multivariate models were constructed by Cox proportional hazard model, which were defined <span class="elsevierStyleItalic">a priori</span> based on the variables that have been shown to influence the AHF prognosis: Model A adjusted for age and sex; Model B, which would add the NYHA class and the Barthel index to model A; Model C, which would add to model B the systolic blood pressure, baseline arterial oxygen saturation and serum creatinine and sodium; and Model D, which would add to model C hospital admission or discharge from the emergency department. It was accepted that there were significant differences when <span class="elsevierStyleItalic">p</span> value was <0.05 or HR 95% CI excluded value 1.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study included 3535 patients: 973 (28%) with no identified PF and 2562 (72%) with PF. These were: infection in 1369 (39%), rapid AF in 636 (18%), anemia in 263 (7%), hypertensive emergency in 255 (7%), nonadherence to therapy or diet in 167 (5%) and NSTEACS in 112 (3%) (228 patients had more than one PF). Comparatively, patients with PFs had high blood pressure more frequently. Less frequently, ischemic heart disease and valvular heart disease; higher systolic blood pressure, heart rate and respiratory rate; lower baseline oxygen saturation and blood hemoglobin concentration, and they were hospitalized less frequently (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Patients with an infection, a rapid AF or a hypertensive emergency had significantly lower revisit rate than patients without PF identified (HR 0.74, 95% CI 0.64–0.85; HR 0.69, 95% CI 0.58–0.83, and HR 0.71, 95% CI 0.55–0.91, respectively). Also, patients with rapid AF or hypertensive emergency had a lower mortality (HR 0.67, 95% CI 0.50–0.89; and HR 0.45, 95% CI 0.28–0.72, respectively), and in patients with NSTEACS it was higher (HR 1.79, 95% CI 1.19–2.70) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In the multivariate analysis, infection and rapid AF continued to have inverse and stable association in all models with revisits to the emergency department, while hypertensive urgency lost that association in maximum models (C and D). Regarding mortality, rapid AF and NSTEACS remained protector and flattering factors, respectively, while hypertensive urgency lost again its association in maximum models (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">PF identification in AHF in 72% cases is in an intermediate zone compared to the reported by other similar studies (50–100%) and infection was, like most of them, the most frequent PF.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,5,6</span></a> Comparing studies is difficult due to the heterogeneity of their fields and designs. Thus, there seems to be an increased ACS rate in those studies conducted in intensive care units and coronary care units,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> or lack of adherence to treatment or diet in patients admitted to cardiology departments.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> There is also a disparity in the PFs used in different studies for analysis. To perform reliable comparisons in future studies they should be standardized following those proposed by the Standardized Reporting Criteria Working Group.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">While some studies have linked infection with increased hospital mortality mainly in patients aged over 75 years,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> others have not detected this association.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,4</span></a> In our series we found no such relationship in any of the 2 PAPRICA studies, but we have found that infection was associated with lower revisit rate.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This finding, not assessed in previous studies, might provide further data to defining the risk profile of revisiting which usually includes comorbidities but not the PF.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The temporary relationship between AF and AHF and its impact on the prognosis has recently been analyzed with mixed results. Thus, in the study by Smit et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> the presence of AF prior to the appearance of AHF was associated with increased survival after discharge, while, on the contrary, in the study of McManus et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> AF <span class="elsevierStyleItalic">de novo</span> was associated with increased mortality in hospital and after discharge. However, no data is available in the literature on the influence on the medium-term prognosis of rapid AF as PF. In our paper, it was associated with lower revisit rate and mortality within 90 days consistently across all models. However, it should be noted that the AF and AHF have a reciprocal relationship, in which both can be cause or effect, and require simultaneous treatment.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The increased mortality and revisits in ACS associated with AHF might be due to the increased progression of coronary heart disease. Our study confirms that, even considering only patients with NSTEACS, the AHF associated with ACS as PF has higher mortality, although these NSTEACS patients did not require further visits after discharge.</p><p id="par0055" class="elsevierStylePara elsevierViewall">As limitations of the study, it should be noted that the identification of a PF may be higher compared to the commonly observed for being the analysis of a record that includes the PF in data collection. However, nonadherence to diet or treatment may have been underdiagnosed because the interview was during the emergency assistance. It has not been analyzed whether or not the management of episodes was adequate (it is a record of routine clinical practice) which might have an impact on the mortality and revisit rates. Finally, it has been verified that the adjustment models have been limited to factors available in any Spanish ED.</p><p id="par0060" class="elsevierStylePara elsevierViewall">However, we believe the results of this study might help clinicians when deciding management strategies that may include discharge directly from the emergency department or admission to short-stay units or to a traditional ward. Furthermore, we believe that this study reinforces the need to identify and correct potential AHF PFs, since they may involve different prognoses, especially if a specific PF treatment is performed.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors report no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres633041" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec645689" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres633042" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec645688" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methodology" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:2 [ "identificador" => "xack213303" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-09-14" "fechaAceptado" => "2015-01-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec645689" "palabras" => array:3 [ 0 => "Heart failure" 1 => "Precipitating factors" 2 => "Prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec645688" "palabras" => array:3 [ 0 => "Insuficiencia cardiaca" 1 => "Factores precipitantes" 2 => "Pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the precipitating factors (PF) associated with acute heart failure and their association with medium-term prognosis.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multipurpose prospective study from the EAHFE Registry. We included as PF: infection, rapid atrial fibrillation (RAF), anemia, hypertensive crisis, non-adherence to diet or drug therapy and non-ST-segment-elevation acute coronary syndrome (NSTEACS). Patients without PF were control group. <span class="elsevierStyleItalic">Hazard ratios</span> (HR) crudes and adjusted for reconsultations and mortality at 90 days were calculated.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">3535 patients were included: 28% without and 72% with PF. Patients with RAF (HR 0.67; 95% CI 0.50–0.89) and hypertensive crisis (HR 0.45; 95% CI 0.28–0.72) had less mortality and patients with NSTEACS (HR 1.79; 95% CI 1.19–2.70) had more mortality. Reconsultation was fewer in patients with infection (HR 0.74; 95% CI 0.64–0.85), RAF (HR 0.69; 95% CI 0.58–0.83) and hypertensive crisis (HR 0.71; 95% CI 0.55–0.91). These differences were maintained in all the adjusted models except for hypertensive crisis.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">One PF is identified in 3 out of 4 patients and it may influence medium-term prognosis. At 90 days, NSTEACS and RAF were associated with more and less mortality respectively, and RAF and infection with less probability of reconsultation.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar los factores precipitantes (FP) asociados a los episodios de insuficiencia cardiaca aguda y si se asocian con el pronóstico a medio plazo.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio multipropósito prospectivo de la cohorte EAHFE. Como FP se incluyeron: infección, fibrilación auricular rápida (FAR), anemia, urgencia hipertensiva, trasgresión terapéutica-dietética, y síndrome coronario agudo sin elevación del ST (SCASEST). Como grupo control se escogió a los pacientes sin FP reconocido. Se calcularon las <span class="elsevierStyleItalic">hazard ratio</span> (HR) crudas y ajustadas para la reconsulta a urgencias y la mortalidad por cualquier causa a 90 días.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 3.535 pacientes, el 72% con FP. Respecto a los pacientes sin FP reconocido, presentaron menor mortalidad los pacientes con FAR (HR 0,67; IC95% 0,50-0,89) y urgencia hipertensiva (HR 0,45; IC95% 0,28-0,72) y mayor los pacientes con SCASEST (HR 1,79; IC95% 1,19-2,70). La reconsulta fue menor en los pacientes con infección (HR 0,74; IC95% 0,64-0,85), FAR (HR 0,69; IC95% 0,58-0,83) y urgencia hipertensiva (HR 0,71; IC95% 0,55-0,91). Estas diferencias persistieron en todos los modelos ajustados, excepto las relacionadas con la urgencia hipertensiva.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En 3 de cada 4 pacientes con insuficiencia cardiaca aguda se identifica un FP, pudiendo este influir en los resultados a medio plazo. El SCASEST y la FAR se asociaron a una mayor y menor mortalidad a 90 días respectivamente, y la FAR y la infección a una menor probabilidad de reconsulta a 90 días.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">The names of the members of ICA-SEMES group are listed in <a class="elsevierStyleCrossRef" href="#sec0030">Appendix 1</a>.</p>" "identificador" => "fn1" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Miró Ò, Aguirre A, Herrero P, Jacob J, Martín-Sánchez FJ, Llorens P, en nombre del grupo ICA-SEMES. Estudio PAPRICA-2: papel del factor precipitante del episodio de insuficiencia cardiaca aguda en el pronóstico a medio plazo. Med Clin (Barc). 2015;145:385–389.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0075" class="elsevierStylePara elsevierViewall">Àngels Pedragosa, Rosa Escoda, Cristina Gil, Marta Fuentes, José Vallés, Víctor Gil, Emmanuel Coloma, José Pavón, Ana Bella Álvarez, Antonio Noval, José M. Torres, Maria Luisa López-Grima, Amparo Valero, Helena Sancho, Paco Ruiz, Maria Isabel Alonso, Antonio Giménez, José Miguel Franco, Sergio Pardo, Ana Belén Mecina, Josep Tost, Jordi Fabregat, Francisco Epelde, Susana Sánchez, Pascual Piñera, Raquel Torres Garate, Aitor Alquezar, Miguel Alberto Rizzi, Fernando Richard, Javier Lucas, Irene Cabello. Esther Rodríguez Adrada, Maria José Pérez-Durá, Eva Salvo, Héctor Alonso, José Manuel Garrido.</p>" "etiqueta" => "Appendix 1" "titulo" => "Members of the research group in acute heart failure of the Spanish Society of Emergency Medicine (ICA-SEMES)" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2297 "Ancho" => 3557 "Tamanyo" => 590757 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Left: cumulative survival curves within 90 days for revisits to the emergency department (above) and mortality (below) depending on the presence of precipitating factors of acute episode of heart failure. Right: crude and adjusted hazard ratios for survival curves of revisits to the emergency room (above) and mortality (below) within 90 days for those precipitating factors of acute episode of heart failure statistically significant in the univariate analysis. Model A: epidemiological factors are included in adjustment (age and sex). Model B: epidemiological (age and sex) and baseline patient condition (NYHA functional class and Barthel index) factors are included in the adjustment. Model C: epidemiological (age and sex), baseline patient condition (functional NYHA class and Barthel index) and the current episode of acute heart failure (systolic blood pressure, blood saturation basal oxygen, creatinine and sodium) factors are included in the adjustment. Model D: epidemiological (age and sex), baseline patient condition (functional NYHA class and Barthel index), the current episode of acute heart failure (systolic blood pressure, baseline arterial oxygen saturation, creatinine and sodium) and final destination of the patient (hospital admission or discharge directly from the emergency department) factors are included in the adjustment.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">LVEF, left ventricular ejection fraction.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">p</span> values considered statistically significant are highlighted in bold.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total<br>No.<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3535 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No precipitating factor identified<br>No.<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>973 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With precipitating factor identified<br>No.<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2562 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Epidemiology</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sex, female, No</span>. <span class="elsevierStyleItalic">(%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2036 (57.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">546 (56.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1490 (58.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Comorbidity, No. (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hypertension</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2943 (83.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">784 (80.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2159 (84.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">0.01</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes mellitus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1438 (40.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">394 (40.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1044 (40.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.92 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dyslipidemia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1417 (40.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">407 (41.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1010 (39.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ischemic heart disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1061 (30.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">322 (33.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">739 (28.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold"><0.05</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Valvular heart disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">906 (25.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">285 (29.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">621 (24.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold"><0.01</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cerebrovascular disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">444 (12.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116 (11.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">328 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Peripheral artery disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">295 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">226 (8.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Permanent atrial fibrillation</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1730 (48.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">455 (48.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1275 (49.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chronic renal failure (creatinine</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mg/dL)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">777 (22.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">219 (22.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">558 (21.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Previous episodes of acute heart failure</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2172 (62.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">615 (64.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1557 (61.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Baseline status prior to decompensation</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">NYHA functional class, No</span>. <span class="elsevierStyleItalic">(%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">789 (22.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">192 (21.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">597 (24.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1676 (47.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">457 (52.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1219 (50.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">755 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">211 (24.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">544 (22.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Barthel index (scores), mean(SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Type of dysfunction (echocardiography), No</span>. <span class="elsevierStyleItalic">(%)</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Systolic dysfunction, No. (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">719 (57.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">231 (61.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">488 (55.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Diastolic dysfunction, No. (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">529 (42.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">143 (32.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">386 (44.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">LVEF, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">LVEF in patients with systolic dysfunction, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Current episode of acute heart failure, mean (SD)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Systolic blood pressure (mmHg</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">143 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">139 (24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">144 (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold"><0.001</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Heart rate (lpm)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold"><0.001</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Respiratory rate (rpm)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold"><0.001</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Baseline arterial oxygen saturation (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold"><0.001</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hemoglobin (g/L)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">121 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">119 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold"><0.05</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Creatinine (mg/dL)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.3 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">0.99</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sodium (mEq/L)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">138 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">138 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">138 (6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Potassium (mEq/L)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.4 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold"><0.05</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleBold">Disposition, No. (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hospitalization</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2765 (78.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">662 (68.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2103 (74.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><<span class="elsevierStyleBold">0.001</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1038323.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">It was recorded in cases where a study conducted 12 months prior to emergency care were available, which occurred in 1248 patients.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients included in this study.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospitalization due to acute heart failure. 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The ICA-SEMES research group has received unrestricted grants, and not directly related to this study, from Orion Pharma and Novartis laboratories.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014500000009/v2_201605020201/S2387020616001789/v2_201605020201/en/main.assets" "Apartado" => array:4 [ "identificador" => "44146" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014500000009/v2_201605020201/S2387020616001789/v2_201605020201/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616001789?idApp=UINPBA00004N" ]
