Analysis of the relationship between ambient air pollution and the severity of heart failure decompensations in two Spanish metropolises (Barcelona and Madrid)

array:24 ["pii" => "S2387020623002401" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.02.012" "estado" => "S300" "fechaPublicacion" => "2023-07-07" "aid" => "6219" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2023;161:11-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775323001434" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.02.016" "estado" => "S300" "fechaPublicacion" => "2023-07-07" "aid" => "6219" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2023;161:11-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Análisis de la relación entre la contaminación del aire ambiente y la gravedad de las descompensaciones por insuficiencia cardiaca en dos metrópolis españolas (Barcelona y Madrid)" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "11" "paginaFinal" => "19" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Analysis of the relationship between ambient air pollution and the severity of heart failure decompensations in two Spanish metropolises (Barcelona and Madrid)" ] ] "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" => "fig1" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1922 "Ancho" => 3311 "Tamanyo" => 339814 ] ] "descripcion" => array:1 [ "es" => "Diagrama de inclusión de pacientes. EAHFE: Epidemiology of Acute Heart Failure in Emergency departments." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miguel Benito-Lozano, Pedro López-Ayala, Sergio Rodríguez, Pere Llorens, Alberto Domínguez-Rodríguez, Alfons Aguirre, Aitor Alquézar, Javier Jacob, Víctor Gil, Francisco Javier Martín-Sánchez, María Mir, Juan Antonio Andueza, Guillermo Burillo-Putze, Òscar Miró" "autores" => array:15 [ 0 => array:2 [ "nombre" => "Miguel" "apellidos" => "Benito-Lozano" ] 1 => array:2 [ "nombre" => "Pedro" "apellidos" => "López-Ayala" ] 2 => array:2 [ "nombre" => "Sergio" "apellidos" => "Rodríguez" ] 3 => array:2 [ "nombre" => "Pere" "apellidos" => "Llorens" ] 4 => array:2 [ "nombre" => "Alberto" "apellidos" => "Domínguez-Rodríguez" ] 5 => array:2 [ "nombre" => "Alfons" "apellidos" => "Aguirre" ] 6 => array:2 [ "nombre" => "Aitor" "apellidos" => "Alquézar" ] 7 => array:2 [ "nombre" => "Javier" "apellidos" => "Jacob" ] 8 => array:2 [ "nombre" => "Víctor" "apellidos" => "Gil" ] 9 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Martín-Sánchez" ] 10 => array:2 [ "nombre" => "María" "apellidos" => "Mir" ] 11 => array:2 [ "nombre" => "Juan Antonio" "apellidos" => "Andueza" ] 12 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Burillo-Putze" ] 13 => array:2 [ "nombre" => "Òscar" "apellidos" => "Miró" ] 14 => array:1 [ "colaborador" => "en representación del grupo ICA-SEMES" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020623002401" "doi" => "10.1016/j.medcle.2023.02.012" "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/S2387020623002401?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323001434?idApp=UINPBA00004N" "url" => "/00257753/0000016100000001/v1_202306261002/S0025775323001434/v1_202306261002/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2387020623002462" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.04.009" "estado" => "S300" "fechaPublicacion" => "2023-07-07" "aid" => "6250" "copyright" => "The Author(s)" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2023;161:20-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Prevalence and impact of cerebrovascular risk factors in patients with giant cell arteritis: An observational study from the Spanish national registry" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "20" "paginaFinal" => "23" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia e impacto de los factores de riesgo cerebrovascular en pacientes con arteritis de células gigantes: un estudio observacional del registro nacional español" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Enrique Sánchez-Chica, María Martínez-Urbistondo, Ángela Gutiérrez Rojas, Raquel Castejón, Juan A. Vargas-Núñez, Víctor Moreno-Torres" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Enrique" "apellidos" => "Sánchez-Chica" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Martínez-Urbistondo" ] 2 => array:2 [ "nombre" => "Ángela" "apellidos" => "Gutiérrez Rojas" ] 3 => array:2 [ "nombre" => "Raquel" "apellidos" => "Castejón" ] 4 => array:2 [ "nombre" => "Juan A." "apellidos" => "Vargas-Núñez" ] 5 => array:2 [ "nombre" => "Víctor" "apellidos" => "Moreno-Torres" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623002462?idApp=UINPBA00004N" "url" => "/23870206/0000016100000001/v2_202311101438/S2387020623002462/v2_202311101438/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2387020623002449" "issn" => "23870206" "doi" => "10.1016/j.medcle.2023.02.013" "estado" => "S300" "fechaPublicacion" => "2023-07-07" "aid" => "6206" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2023;161:1-10" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Improvement of left ventricular ejection fraction in patients with heart failure with reduced ejection fraction: Predictors and clinical impact" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "10" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto clínico a medio plazo de la mejoría de la fracción de eyección ventricular izquierda en pacientes con insuficiencia cardiaca con fracción de eyección reducida" ] ] "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" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1692 "Ancho" => 2508 "Tamanyo" => 189516 ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier curves of time to readmission for heart failure in patients with improved LVEF. Estimates of the probability of hospital readmission for heart failure for patients with HFimpEF and HFsrEF and patients at risk are shown. HFimpEF: Heart Failure with Improved Ejection Fraction; HFsrEF: Heart Failure with Sustained Reduced Ejection Fraction." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jorge Perea-Armijo, José López-Aguilera, Rocío Sánchez-Prats, Juan Carlos Castillo-Domínguez, Rafael González-Manzanares, Martín Ruiz-Ortiz, Dolores Mesa-Rubio, Manuel Anguita-Sánchez" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Jorge" "apellidos" => "Perea-Armijo" ] 1 => array:2 [ "nombre" => "José" "apellidos" => "López-Aguilera" ] 2 => array:2 [ "nombre" => "Rocío" "apellidos" => "Sánchez-Prats" ] 3 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Castillo-Domínguez" ] 4 => array:2 [ "nombre" => "Rafael" "apellidos" => "González-Manzanares" ] 5 => array:2 [ "nombre" => "Martín" "apellidos" => "Ruiz-Ortiz" ] 6 => array:2 [ "nombre" => "Dolores" "apellidos" => "Mesa-Rubio" ] 7 => array:2 [ "nombre" => "Manuel" "apellidos" => "Anguita-Sánchez" ] 8 => array:1 [ "colaborador" => "on behalf of the working group of the Heart Failure Unit of Reina Sofia Hospital" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623002449?idApp=UINPBA00004N" "url" => "/23870206/0000016100000001/v2_202311101438/S2387020623002449/v2_202311101438/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Analysis of the relationship between ambient air pollution and the severity of heart failure decompensations in two Spanish metropolises (Barcelona and Madrid)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "11" "paginaFinal" => "19" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Miguel Benito-Lozano, Pedro López-Ayala, Sergio Rodríguez, Pere Llorens, Alberto Domínguez-Rodríguez, Alfons Aguirre, Aitor Alquézar, Javier Jacob, Víctor Gil, Francisco Javier Martín-Sánchez, María Mir, Juan Antonio Andueza, Guillermo Burillo-Putze, Òscar Miró" "autores" => array:15 [ 0 => array:3 [ "nombre" => "Miguel" "apellidos" => "Benito-Lozano" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "1" "identificador" => "fn0005" ] ] ] 1 => array:3 [ "nombre" => "Pedro" "apellidos" => "López-Ayala" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "1" "identificador" => "fn0005" ] ] ] 2 => array:3 [ "nombre" => "Sergio" "apellidos" => "Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Pere" "apellidos" => "Llorens" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Alberto" "apellidos" => "Domínguez-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Alfons" "apellidos" => "Aguirre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "Aitor" "apellidos" => "Alquézar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "Javier" "apellidos" => "Jacob" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 8 => array:3 [ "nombre" => "Víctor" "apellidos" => "Gil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 9 => array:3 [ "nombre" => "Francisco Javier" "apellidos" => "Martín-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "j" "identificador" => "aff0050" ] ] ] 10 => array:3 [ "nombre" => "María" "apellidos" => "Mir" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "k" "identificador" => "aff0055" ] ] ] 11 => array:3 [ "nombre" => "Juan Antonio" "apellidos" => "Andueza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "l" "identificador" => "aff0060" ] ] ] 12 => array:4 [ "nombre" => "Guillermo" "apellidos" => "Burillo-Putze" "email" => array:1 [ 0 => "gburillo@telefonica.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 13 => array:3 [ "nombre" => "Òscar" "apellidos" => "Miró" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 14 => array:2 [ "colaborador" => "on behalf of the ICA-SEMES group" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "2" "identificador" => "fn0010" ] ] ] ] "afiliaciones" => array:12 [ 0 => array:3 [ "entidad" => "Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto de Productos Naturales y Agrobiología (IPNA), CSIC, La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Tenerife, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital del Mar, Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Área de Urgencias, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, Spain" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "l" "identificador" => "aff0060" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de la relación entre la contaminación del aire ambiente y la gravedad de las descompensaciones por insuficiencia cardiaca en dos metrópolis españolas (Barcelona y Madrid)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1922 "Ancho" => 3311 "Tamanyo" => 334577 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Patient inclusion diagram. EAHFE: Epidemiology of Acute Heart Failure in Emergency departments." ] ] ] "textoCompleto" => "IntroductionNumerous epidemiological and observational studies have shown that poor air quality due to air pollutants has an impact on cardiovascular health.<a class="elsevierStyleCrossRefs" href="#bib0005">1–4</a> WHO estimates that ambient air pollution causes about 8 million premature deaths worldwide each year, and that 40% of these deaths are due to cardiovascular causes.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Even brief exposures have been associated with increases in cardiovascular mortality,<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> particularly in susceptible populations and those with comorbidities, including cardiovascular conditions.In this regard, heart failure (HF) is a growing public health problem affecting more than 23 million people worldwide, with an increasing prevalence in older people.<a class="elsevierStyleCrossRefs" href="#bib0040">8–10</a> It has a high mortality, which occurs especially during episodes of decompensation. Thus, acute HF (AHF) is one of the most common reasons for hospitalisation and re-hospitalisation in the elderly, accounting for 5% of all hospital discharge diagnoses. Mortality at one year of the AHF episode is around 30%.<a class="elsevierStyleCrossRefs" href="#bib0055">11–13</a> Triggers for AHF, especially in susceptible individuals, are therefore a major public health concern. Numerous causes of decompensation,<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a> as well as factors associated with an increased risk of developing adverse events have been described over the past decades.<a class="elsevierStyleCrossRefs" href="#bib0080">16–18</a>The relationship between ambient air quality and the outcome of HF patients has been less studied, in contrast to the extensive knowledge on the relationship between air quality and acute cardiovascular diseases such as myocardial infarction.<a class="elsevierStyleCrossRefs" href="#bib0095">19–21</a> However, the associations found between air pollution and acute coronary syndrome cannot be directly translated, as there are major differences in the mechanisms that trigger myocardial infarction compared to AHF.<a class="elsevierStyleCrossRefs" href="#bib0110">22–24</a> In addition, much of the previous research has consisted of epidemiological studies based on time series analysis in general populations investigating the incidence of specific cardiovascular diseases, including HF<a class="elsevierStyleCrossRef" href="#bib0055">11</a> or global or cardiovascular patterns of mortality related to environmental conditions.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> Surprisingly, none have analysed the severity of decompensations and the risk of adverse events in AHF in relation to ambient air pollutants in cohorts of HF patients. Therefore, our aim was to investigate the relationship between air pollution and the severity of HF decompensation using a cohort of patients that included both inpatients and outpatients treated for HF decompensation, i.e., severe and not so severe patients.MethodScope of the studyThe present study is a sub-analysis of the EAHFE Registry. The EAHFE Registry is a prospective, multi-centre cohort study initiated in 2007. Every 2–3 years it conducts a 1–2 month screening of all consecutive patients diagnosed with AHF in Spanish hospital emergency departments (EDs) participating in the project. There is no planned intervention and patient management is based entirely on the decisions of the treating physician in the ED. The only exclusion criterion is the development of AHF during ST-segment elevation myocardial infarction, as many of these patients go directly to the cath lab for revascularisation, bypassing the ED. To date, 7 screening phases have been carried out (2007, 2009, 2011, 2014, 2016, 2018 and 2019), 45 EDs from Spanish regional and reference hospitals have participated (representing around 15% of the hospitals in the Spanish public health system), and 19,947 patients with AHF have been included. The details of the dynamics of inclusion and the working protocol have been previously published.<a class="elsevierStyleCrossRefs" href="#bib0055">11,25,26</a>Study designPatients diagnosed with decompensated HF in the emergency department of 4 hospitals in Barcelona (Hospital Clínic, Hospital de la Santa Creu i Sant Pau, Hospital del Mar and Hospital Universitari de Bellvitge) and 3 in Madrid (Hospital Clínico San Carlos, Hospital Universitario Gregorio Marañón and Hospital Universitario Infanta Leonor) and included in the EAHFE registry during phases 2–7 (in total, 336 days of inclusion) were included. Clinical data were collected for these patients, including age, sex, 13 comorbidities and 2 variables of their baseline functional status: degree of dependency according to the Barthel index and respiratory class according to the NYHA scale. In addition, 2 atmospheric variables, maximum daily temperature and pressure, were collected, which may influence the severity of decompensations.<a class="elsevierStyleCrossRefs" href="#bib0135">27,28</a> Following the methodology used in other studies, the atmospheric pressure was expressed as a pressure anomaly, which is the difference between the maximum pressure of each day and the average maximum pressure of that city.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> This corrects for the difference in atmospheric pressure between Barcelona and Madrid due to their different altitude above sea level.Exposure variableThe air pollutant measurements were carried out by the air quality monitoring network, managed by the Generalitat de Catalunya (Catalonia Government), the Comunidad de Madrid (Madrid Community Government) and the Ayuntamiento de Madrid (Madrid City Council), under the coordination of the Ministerio para la Transición Ecológica y el Reto Demográfico (Ministry for Ecological Transition and the Demographic Challenge). Daily average concentrations were collected for 4 gaseous pollutants (sulphur dioxide [SO2], nitrogen dioxide [NO2], carbon monoxide [CO] and ozone [O3]) and particulate matter smaller than 10 and 2.5μ, i.e., PM10 and PM2.5, respectively, on the day of the patient’s visit to ED. The levels of pollutants and particulate matter on the day of the ED visit were chosen to be recorded following the methodology of similar recent studies that assess ED care in terms of environmental pollution.<a class="elsevierStyleCrossRefs" href="#bib0150">30,31</a>The data corresponding to the hospitals in Barcelona were obtained from the data portal of the Generalitat de Catalunya, in the section corresponding to environment and sustainability: automatic data download.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> It contains hourly data on pollutants collected at the automatic measuring points of the Air Pollution Monitoring and Forecasting Network since 1991. The Barcelona Sants and Barcelona Eixample stations were chosen because between them all pollutants were accessible throughout the study period (except for PM2.5 concentrations in 2009, which were not recorded) and because they are located in the city centre and close to the participating hospitals (less than 5km away). Air quality data for hospitals in Madrid were obtained from the open data portal of the Madrid City Council, under data catalogue: air quality, where daily data since 2001<a class="elsevierStyleCrossRef" href="#bib0165">33</a> can be found. The measurements used were specifically those collected at the Escuelas Aguirre measurement station, which had data available for all pollutants during the whole study period and is located in the centre of Madrid and close to the participating hospitals (less than 5km away).Units are expressed in μg/m3 for all pollutants except CO, which is expressed in mg/m3. At all stations, air pollutants were measured using the EU reference methods: ultraviolet fluorescence (SO2), chemiluminescence (NO2), non-dispersive infrared absorption (CO), ultraviolet absorption (O3) and oscillating microbalance technique converted to gravimetric equivalents (PM10 and PM2,5).Outcome variablesSeverity of decompensation was estimated by all-cause mortality during the 7 days following ED consultation, and this was the primary outcome indicator. As secondary indicators, the need for admission after emergency care, in-hospital mortality for hospitalised patients, and prolonged hospitalisation (>7 days) for hospitalised patients discharged alive after such hospitalisation were used. To determine the occurrence of the episode, medical records were reviewed or patients or their relatives were contacted by telephone when there were no clear data in the medical records or access to them was not possible. Episode adjudication was done locally by the principal investigator of the centre, without external review.Statistical analysisQualitative data are expressed as absolute frequencies and percentages, and quantitative data as medians and interquartile range (IQR). A two-pronged approach was used to analyse the association between severity criteria and ambient air pollutant concentrations. On the one hand, it was assumed that there was linearity in the relationship between them, as has been the case in many of the studies published so far and in the meta-analysis published by Shah et al.<a class="elsevierStyleCrossRef" href="#bib0170">34</a> For this, a logistic regression analysis was used and the increase in odds ratio (OR, with its 95% confidence interval [CI]) of episode per unit increase in pollutant was calculated. This estimate was adjusted for clinical and atmospheric variables, city and other pollutants studied. On the other hand, to avoid imposing linearity, we have used a restricted cubic spline (RCS) function to model the continuous association of pollutant concentration and the primary and secondary indicators of decompensation severity. Five spline knots were placed at the 5th, 27.5, 50th, 50th, 72.5 and 95th centiles of the marginal distribution of each continuous variable, following Harrel’s recommendations.<a class="elsevierStyleCrossRef" href="#bib0175">35</a> The magnitude of the effect of each contaminant unit change was assessed by logistic regression and dose-response curves were used to represent the ORs and their 95% CIs, adjusted for the same covariates defined for logistic regression. The choice of reference pollutant concentration values for the calculation of the ORs in the dose-response plots was made on the basis of biological, environmental and sample distribution criteria. No replacement of missing values was carried out. All hypothesis tests were 2-tailed and p-values of p<0.05, or OR with 95% CI excluding value 1, were considered statistically significant. Data analysis was performed with Statistical Package for Social Sciences version 23.0 (IBM, Armonk, NY, USA) and Stata version 16.1 (Stata Corp, College Station, TX, USA), and some graphs were prepared with Microsoft Office Power Point version 2019 (Microsoft Corporate Office, Redmond, Washington, USA).Ethical considerationsThe ethical principles of the Declaration of Helsinki were followed and informed consent was sought from all patients to participate in the study. The EAHFE registry protocol was approved by the Clinical Research Ethics Committee of the Hospital Universitario Central de Asturias as the main committee (protocols 49/2010, 69/2011, 166/13, 160/15 and 205/17), and by those of the rest of the participating centres.Results5292HF decompensations were included, 3231 in Barcelona and 2061 in Madrid (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The median age of the patients was 83 years (IQR=76–88) and 56% were women. Patients had many comorbidities, and more than half had hypertension, previous HF decompensations, dyslipidaemia and atrial fibrillation (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). As regards their baseline status, 22.4% were in NYHA respiratory class iii–iv and 61,9% had some degree of dependency (Barthel index<100 points), which was severe or absolute in 15.6% of cases (Barthel<60 points). The median (IQR) daily average pollutant concentrations were: SO2=2,5μg/m3 (1,4–7,0), NO2=43μg/m3 (34–57), CO=0,48mg/m3 (0,35–0,63), O3=35μg/m3 (25–48), PM10=22μg/m3 (15–31) y PM2,5=12μg/m3 (8–17). The distribution of these daily mean concentrations on the study days is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. The number of missing data was less than 1% for most of the variables collected, and none of them exceeded 10% (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Seven-day mortality was 3.9%, and hospitalisation, in-hospital mortality and prolonged hospitalisation were 78.9, 6.9 and 47.5%, respectively (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No environmental pollutant showed a significant linear association with severity indicators, with the exception of the direct relationship between SO2 concentration and need for hospitalisation (OR=1.04, 95% CI 1.01–1.08; <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). All other associations were very close to zero, and only CO concentration showed a tendency to be associated with 7-day mortality (OR=1.04, 95% CI 0.97–1.10) or in-hospital mortality (OR=1.03, 95% CI 0.98–1.08; <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>The study using RCS curves also showed no clear associations between pollutant concentration and severity of decompensation (Appendix B — Supplementary Fig.). The specific analysis of the relationship between SO2 concentration and need for hospitalisation showed association starting at concentrations of 15μg/m3 (OR of 1.55 compared to the reference concentration of 5μg/m3, 95% CI 1.01–2.36) and rising with increasing concentrations, reaching an OR of 2.71 for a concentration of 24μg/m3 (95% CI 1.13–6.49) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Dose-response curves for the relationship between CO and mortality showed no associations (Appendix B Supplementary Fig.).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>DiscussionAir pollution is increasingly recognised as an important and modifiable determinant of cardiovascular disease in urban communities. Acute exposure has been associated with a variety of adverse cardiovascular events, including hospital admissions with angina, myocardial infarction and HF.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Air pollution has a strong temporal association with HF hospitalisation and mortality. Although more studies in developing countries are needed to confirm the findings of studies conducted mostly in developed countries, air pollution is a widespread public health problem with important cardiovascular and health economic consequences and should remain a key target for global health policy.<a class="elsevierStyleCrossRef" href="#bib0170">34</a>The present study found no overall significant association between air pollutants and severity of decompensation in a cohort of HF patients. We have only identified some association between the need for hospitalisation and SO2 concentrations, with an OR of 1.04 for hospitalisation per each μg/m3 unit increase in SO2. The apparent relationship between CO and mortality found in the linear model was not confirmed in the RCS analysis. These relatively neutral findings contrast with previous studies that have shown a relationship between pollution and the number of hospitalisations and HF deaths. Specifically, the meta-analysis by Shah et al.<a class="elsevierStyleCrossRef" href="#bib0170">34</a> showed that HF hospitalisation was associated with all pollutants analysed in our study, and HF mortality with all but CO and PM10. In their study, the magnitudes of the associations ranged from 1 to 3% increments for each unit increase in pollutant.Possible reasons for this discrepancy include the fact that pollution in Barcelona and Madrid was not very high in the periods analysed. Thus, analysing the pollutant distributions, the median (IQR) of the daily pollutant averages were: SO2=2,5μg/m3 (1,4–7,0), NO2=43μg/m3 (34–57), CO=0,48mg/m3 (0,35–0,63), O3=35μg/m3 (25–48), PM10=22μg/m3 (15–31) and PM2,5=12μg/m3 (8–17). In this sense, when analysing the data in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, the only pollutant that shows relatively high levels (and not very high) is SO2, precisely the only one that showed some association with the severity of decompensation, and specifically with the need for hospitalisation. The rest of the pollutants show rather low values during all study days, indicating that the lack of association with these other pollutants may have been because there was no record of days with high concentrations of these other pollutants. Alternatively, or in addition, it could be that estimation in the form of daily averages may not have captured peaks of maximum pollution, which may last only a few hours. Finally, it is possible that the effects of pollution on patients with chronic diseases, such as HF, may be cumulative over days, and a point estimate may not allow a significant association to be found. In this respect, we should be cautious, as our study design only shows an absence of evidence and does not confirm an absence of effect of the pollutant on the severity of AHF decompensation. The study by Díaz-Chirón et al.,<a class="elsevierStyleCrossRef" href="#bib0180">36</a> which related the size of the infarct area in patients with acute coronary syndrome to the concentration of SO2, NO2, CO, O3, benzene, toluene, xylene and particulate matter in 216 patients in Asturias, only found a relationship in the multivariate analysis with SO2 levels. However, that study used a 7-day lag in the environmental data prior to the cardiovascular event. Along the same lines, the only noteworthy relationship in our study is precisely the one established between SO2 and the need for hospitalisation. Hospitalisation is a sensitive marker of the effects of pollution as a trigger for acute processes, such as acute asthma episodes.<a class="elsevierStyleCrossRef" href="#bib0185">37</a> AHF is also among these processes.We found no association with mortality either at 7 days (primary study indicator) or during hospitalisation (in-hospital). In this case, it is possible that since the study only recorded all-cause mortality, without distinguishing between cardiovascular and non-cardiovascular causes of death, it cannot be compared with previous studies. A more detailed analysis of the causes of death could have helped to better explain the true cardiovascular effect of the ambient air pollutants studied. However, we should be cautious as our study only shows an absence of evidence and does not confirm evidence of no effect of most pollutants on the severity of AHF decompensation.Finally, our study underlines the importance of a more flexible and dynamic analysis of the relationship between a continuous variable, such as pollutant concentration, and an outcome. Indeed, the assumption of a linear relationship between them may ignore important relationships between disease, physiology and prognosis. This can be seen in our study, which, when using RCS-based models, provided more detailed data on the associations between pollutants and severity of decompensation (in particular SO2 and hospitalisation). Therefore, there is an opportunity for artificial intelligence applications, some of which have been shown to perform better on such variables, whereby this same technology could offer solutions for the analysis between environmental variables and health outcomes in both healthy and chronically ill populations.<a class="elsevierStyleCrossRefs" href="#bib0190">38,39</a>LimitationsFirstly, several confounding factors make it difficult to study ambient air pollution-related morbidity and mortality. Although daily atmospheric temperature and pressure were taken into account, other conditions such as wind, humidity or trends in changes over the immediately preceding or following days were not included in our models. In this sense, the analysis of the average pollution values on the days prior to the ED consultation could perhaps have yielded a different result. However, Rodríguez et al. showed that admissions for cardiovascular disease in Castilla-La Mancha were not related to the concentration of PM2.5, PM10 and NO2 and daily cardiovascular hospitalisations even considering an exposure period of up to 7 days prior to emergency department care.<a class="elsevierStyleCrossRef" href="#bib0200">40</a> Second, some pollutants, such as ozone, have a strong seasonal cycle, with high levels in summer and low levels in the other seasons, especially in winter. Our study did not include the summer season and most days were winter days, so this may have influenced our inability to demonstrate an association for this pollutant. Third, this study was carried out in the urban areas of Barcelona and Madrid, and not all pollutants reach their highest concentrations in these areas. Thus, ozone is often elevated in rural areas on a regional level because its reaction with fresh nitric oxide from vehicle exhaust emissions leads to its titration. In addition, and in comparison with other studies, the pollution values on the days studied were not excessively high. This may have limited the number of positive associations found between contaminants and severity of AHF decompensation. Fourth, although the sample was large, some estimates may have been subject to a type-II error, as no sample size calculation was performed. Therefore, the lack of statistical significance should be interpreted as “no evidence” rather than “evidence of absence” of a relationship between pollution and severity of AHF episode. Fifth, since there was no replacement of missing values, there may have been a bias in the event that the loss of values did not occur by chance, which we are unable to determine. Sixth, the adjudication of the results was carried out at the local level. However, we use easily identifiable and unambiguous results to overcome the need for external adjudication. Seventh, although performed in a single country, the organisation of care for HF patients is not uniform in all Spanish territories,<a class="elsevierStyleCrossRefs" href="#bib0205">41,42</a> and different strategies for patient hospitalisation may affect the results. On the other hand, Spain has a national public health system that may impact on health outcomes in a different way than other systems, so external validation is necessary prior to the generalisation of these results. Eighth, measurements of pollutants and particulate matter in the hospital area may not reflect the reality of exposure for a number of patients whose residence is far away from the hospital. However, the health policy in Barcelona and Madrid is that each patient is treated in his or her reference hospital, a fact that is fulfilled in a high percentage of cases, and therefore we believe that measurements in the hospital area can be very close to those of the patient’s home area in most cases. Finally, since this study was conducted in a real-life registry setting, it included a high percentage of elderly patients with AHF (who are usually excluded from clinical trials), predominantly with preserved ejection fraction, in whom frailty and dependency are common, and these are 2 factors strongly related to mortality.<a class="elsevierStyleCrossRef" href="#bib0120">24</a>ConclusionAmbient air pollutants are not clearly related to the severity of HF decompensations in cities with moderate concentrations of ambient air pollutants, such as those recorded in the present study in Barcelona and Madrid during the period 2007–2019. Only an association between increased SO2 concentration and the need for HF hospitalisation was observed. Further studies analysing the relationship between ambient air pollutants and the severity of HF decompensation, with the help of artificial intelligence applications, would be needed.FundingThis work was made possible in part by grants from the Instituto de Salud Carlos III with funding from the Ministry of Health and FEDER (PI15/01019, PI18/00393), La Marató de TV3 (2015/2510) and the Generalitat de Catalunya for consolidated research groups (GRC 2009/1385, 2014/0313, 2017/1424).Conflict of interestThe authors declare that they have no conflict of interest with respect to this study." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2008320" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1720688" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2008321" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1720689" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Scope of the study" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study design" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Exposure variable" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Outcome variables" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Ethical considerations" ] ] ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0050" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-12-19" "fechaAceptado" => "2023-02-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1720688" "palabras" => array:4 [ 0 => "Acute heart failure" 1 => "Contamination" 2 => "Mortality" 3 => "Emergency Department" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1720689" "palabras" => array:4 [ 0 => "Insuficiencia cardiaca aguda" 1 => "Contaminación del aire ambiente" 2 => "Mortalidad" 3 => "Servicios de urgencias" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesTo analyze whether the high levels of air pollutants are related to a greater severity of decompensated heart failure (HF). MethodPatients diagnosed with decompensated HF in the emergency department of 4 hospitals in Barcelona and 3 in Madrid were included. Clinical data (age, sex, comorbidities, baseline functional status), atmospheric (temperature, atmospheric pressure) and pollutant data (SO2, NO2, CO, O3, PM10, PM2.5) were collected in the city on the day of emergency care. The severity of decompensation was estimated using 7-day mortality (primary indicator) and the need for hospitalization, in-hospital mortality, and prolonged hospitalization (secondary indicators). The association adjusted for clinical, atmospheric and city data between pollutant concentration and severity was investigated using linear regression (linearity assumption) and restricted cubic spline curves (no linearity assumption). ResultsA total of 5292 decompensations were included, with a median age of 83 years (IQR=76–88) and 56% women. The medians (IQR) of the daily pollutant averages were: SO2=2.5μg/m3 (1.4–7.0), NO2=43μg/m3 (34–57), CO=0.48mg/m3 (0.35–0.63), O3=35μg/m3 (25–48), PM10=22μg/m3 (15–31) and PM2.5=12μg/m3 (8–17). Mortality at 7 days was 3.9%, and hospitalization, in-hospital mortality, and prolonged hospitalization were 78.9, 6.9, and 47.5%, respectively. SO2 was the only pollutant that showed a linear association with the severity of decompensation, since each unit of increase implied an OR for the need for hospitalization of 1.04 (95% CI 1.01–1.08). The restricted cubic spline curves study also did not show clear associations between pollutants and severity, except for SO2 and hospitalization, with OR of 1.55 (95% CI 1.01–2.36) and 2.71 (95% CI 1.13–6.49) for concentrations of 15 and 24μg/m3, respectively, in relation to a reference concentration of 5μg/m3. ConclusionExposure to ambient air pollutants, in a medium to low concentration range, is generally not related to the severity of HF decompensations, and only SO2 may be associated with an increased need for hospitalization." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosAnalizar si la exposición a contaminantes del aire en 2 grandes ciudades españolas está relacionada con la gravedad de las descompensaciones de la insuficiencia cardiaca (IC). MétodoSe estudiaron pacientes con IC descompensada en urgencias de 4 hospitales de Barcelona y 3 de Madrid. Se recogieron datos clínicos (edad, sexo, comorbilidades, situación funcional basal), atmosféricos (temperatura, presión atmosférica) y de contaminantes (SO2, NO2, CO, O3, PM10, PM2,5) el día de atención en urgencias. La gravedad de la descompensación se estimó mediante la mortalidad a 7 días (indicador primario) y la necesidad de hospitalización, mortalidad intrahospitalaria y hospitalización prolongada (indicadores secundarios). Se investigó la asociación ajustada por datos clínicos, atmosféricos y ciudad entre concentración de contaminantes y gravedad, mediante regresión logística (asunción de linealidad) y curvas spline cúbicas restringidas (no asunción de linealidad). ResultadosSe incluyeron 5.292 descompensaciones, con edad mediana de 83 años (RIC=76–88) y 56% mujeres. Las medianas (RIC) de los promedios diarios de contaminantes fueron: SO2=2,5μg/m3 (1,4–7,0), NO2=43μg/m3 (34–57), CO=0,48mg/m3 (0,35–0,63), O3=35μg/m3 (25–48), PM10=22μg/m3 (15–31) y PM2,5=12μg/m3 (8–17). La mortalidad a 7 días fue del 3,9%, y la hospitalización, la mortalidad intrahospitalaria y la hospitalización prolongada, del 78,9, 6,9 y 47,5%, respectivamente. El SO2 fue el único contaminante que mostró asociación lineal con la gravedad de la descompensación, ya que cada unidad de incremento supuso una OR para necesidad de hospitalización de 1,04 (IC 95% 1,01–1,08). El estudio mediante curvas spline cúbicas restringidas tampoco mostró asociaciones nítidas entre contaminantes y gravedad, excepto para SO2 y hospitalización, con OR de 1,55 (IC 95% 1,01–2,36) y de 2,71 (IC 95% 1,13–6,49) para concentraciones de 15 y 24μg/m3, respectivamente, en relación con una concentración de referencia de 5μg/m3. ConclusiónLa exposición a contaminantes del aire ambiente, en un rango de concentraciones medio a bajo, en general no está relacionado con la gravedad de las descompensaciones de la IC, y solo el SO2 podría estar asociado a una mayor necesidad de hospitalización." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "Both authors had the same contribution to the article and both should be considered as first authors." "identificador" => "fn0005" ] 1 => array:3 [ "etiqueta" => "2" "nota" => "The names of the components of the ICA-SEMES group are listed in <a class="elsevierStyleCrossRef" href="#sec0075">Appendix A</a>." "identificador" => "fn0010" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:2 [ 0 => array:4 [ "apendice" => "Marta Fuentes, Cristina Gil (Hospital Universitario de Salamanca), Héctor Alonso, Enrique Pérez-Llantada (Hospital Marqués de Valdecilla de Santander), Francisco Javier Martín-Sánchez, Guillermo Llopis García, Mar Suárez Cadenas (Hospital Clínico San Carlos de Madrid), Òscar Miró, Víctor Gil, Rosa Escoda, Sira Aguiló, Carolina Sánchez (Hospital Clínic de Barcelona), Carmen Gargallo (Hospital Politécnic La Fe de Valencia), José Pavón (Hospital Dr. Negrín de Las Palmas de Gran Canaria), Antonio Noval (Hospital Insular de Las Palmas de Gran Canaria), María Luisa López-Grima, Amparo Valero, María Ángeles Juan (Hospital Dr. Peset de Valencia), Alfons Aguirre, Maria Angels Pedragosa, Silvia Mínguez Masó (Hospital del Mar de Barcelona), María Isabel Alonso, Francisco Ruiz (Hospital de Valme de Sevilla), José Miguel Franco (Hospital Miguel Servet de Zaragoza), Ana Belén Mecina (Hospital de Alcorcón, Madrid), Josep Tost, Marta Berenguer, Ruxandra Donea (Consorci Sanitari de Terrassa, Barcelona), Susana Sánchez Ramón, Virginia Carbajosa Rodríguez (Hospital Universitario Río Hortega de Valladolid), Pascual Piñera, José Andrés Sánchez Nicolás (Hospital Reina Sofía de Murcia), Raquel Torres Garate (Hospital Severo Ochoa de Madrid), Aitor Alquézar-Arbé, Miguel Alberto Rizzi, Sergio Herrera (Hospital de la Santa Creu i Sant Pau de Barcelona), Javier Jacob, Alex Roset, Irene Cabello, Antonio Haro (Hospital Universitari de Bellvitge de Barcelona), Fernando Richard, José María Álvarez Pérez, María Pilar López Diez (Hospital Universitario de Burgos), Pablo Herrero Puente, Joaquín Vázquez Álvarez, Belén Prieto García, María García García, Marta Sánchez González (Hospital Universitario Central de Asturias, Oviedo), Pere Llorens, Patricia Javaloyes, Inmaculada Jiménez, Néstor Hernández, Begoña Espinosa, Adriana Gil, Francisca Molina, Tamara García (Hospital General de Alicante), Juan Antonio Andueza (Hospital General Universitario Gregorio Marañón de Madrid), Rodolfo Romero (Hospital Universitario de Getafe, Madrid), Martín Ruíz, Roberto Calvache (Hospital del Henares de Coslada, Madrid), María Teresa Lorca Serralta, Luis Ernesto Calderón Jave (Hospital del Tajo de Aranjuez, Madrid), Beatriz Amores Arriaga, Beatriz Sierra Bergua (Hospital Clínico Lozano Blesa de Zaragoza), Enrique Martín Mojarro, Brigitte Silvana Alarcón Jiménez (Hospital Sant Pau i Santa Tecla de Tarragona), Lisette Travería Bécquer, Guillermo Burillo (Hospital Universitario de Canarias de La Laguna, Tenerife), Lluís Llauger García, Gerard Corominas LaSalle (Hospital Universitari de Vic, Barcelona), Carmen Agüera Urbano, Ana Belén García Soto, Elisa Delgado Padial (Hospital Costa del Sol de Marbella, Málaga), Ester Soy Ferrer, María Adroher Muñoz (Hospital Josep Trueta de Girona), José Manuel Garrido (Hospital Virgen Macarena de Sevilla), Francisco Javier Lucas-Imbernón (Hospital General Universitario de Albacete), Rut Gaya (Hospital Juan XXIII de Marbella, Málaga), Francisco Javier Lucas-Imbernón (Hospital General Universitario de Albacete), Rut Gaya (Hospital Juan XXIII de Tarragona), Carlos Bibiano, María Mir, Beatriz Rodríguez (Hospital Infanta Leonor de Madrid), José Luis Carballo (Complejo Hospitalario Universitario de Ourense), Esther Rodríguez-Adrada, Belén Rodríguez Miranda, Monika Vicente Martín (Hospital Rey Juan Carlos de Móstoles, Madrid). Pere Coma Casanova, Joan Espinach Alvarós (Hospital Sant Joan de Déu de Martorell, Barcelona)." "etiqueta" => "Appendix A" "titulo" => "Researchers of the AHF-SEMES group" "identificador" => "sec0075" ] 1 => array:4 [ "apendice" => "The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix B" "titulo" => "Supplementary data" "identificador" => "sec0085" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1922 "Ancho" => 3311 "Tamanyo" => 334577 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Patient inclusion diagram. EAHFE: Epidemiology of Acute Heart Failure in Emergency departments." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1841 "Ancho" => 3258 "Tamanyo" => 330566 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Distribution of daily mean ambient air pollutant concentrations on the study days." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2869 "Ancho" => 3167 "Tamanyo" => 642381 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Adjusted analysis of the association between the different pollutants analysed in this study and markers of heart failure decompensation severity. CI: confidence interval." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1917 "Ancho" => 3175 "Tamanyo" => 305059 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Adjusted dose-response curve constructed using a restricted cubic spline curve showing the odds ratio (OR) (with 95% confidence interval [95% CI]) of the pollutant (SO2) that in the linear association study showed a direct association with one of the severity indicators (need for hospitalisation)." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "NYHA: New York Heart Association; IQR: interquartile range." "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Total (N=5292) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Missing values \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Demographic data</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 (76−88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.970 (56.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comorbidities</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.517 (85.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous heart failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.301 (65.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">249 (4.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.827 (53.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atrial fibrillation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.718 (51.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (0.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.117 (41.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic Kidney Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.614 (30.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heart valve disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.547 (29.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ischemic heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.514 (28.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic obstructive pulmonary disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.251 (23.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (0.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neoplasm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">815 (16.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">374 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cerebrovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">757 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral artery disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">619 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dementia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">565 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">376 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Functional capacity</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barthel Index (points), median (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90 (70−100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">342 (6.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NYHA class III–IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.138 (22.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">203 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atmospheric conditions</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum temperature \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.6 (13.2–18.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maximum atmospheric pressure anomaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (−4.8 to 5.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Daily average concentration of pollutants</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sulphur dioxide (SO2), μg/m3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 (1.4–7.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nitrogen dioxide (NO2), μg/m3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (34–57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carbon monoxide (CO), mg/m<a class="elsevierStyleCrossRef" href="#bib0015">3</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.49 (0.35–0.63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ozone (O3), μg/m<a class="elsevierStyleCrossRef" href="#bib0015">3</a>×4_" \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (24–47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (0.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Particulate matter<10μ in diameter (PM10), μg/m3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (15–31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Particulate matter<2,5μ in diameter (PM2,5), μg/m3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (8−17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">256 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3334765.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients included in the study." ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 257070 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:42 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An association between air pollution and mortality in six US cities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.W. Dockery" 1 => "C.A. Pope 3rd" 2 => "X. Xu" 3 => "J.D. Spengler" 4 => "J.H. Ware" 5 => "M.E. Fay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199312093292401" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1993" "volumen" => "329" "paginaInicial" => "1753" "paginaFinal" => "1759" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8179653" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Hoek" 1 => "B. Brunekreef" 2 => "S. Goldbohm" 3 => "P. Fischer" 4 => "P.A. van den Brandt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(02)11280-3" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2002" "volumen" => "360" "paginaInicial" => "1203" "paginaFinal" => "1209" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12401246" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular mortality and long-term exposure to particulate air pollution: epidemiological evidence of general pathophysiological pathways of disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Pope 3rd" 1 => "R.T. Burnett" 2 => "G.D. Thurston" 3 => "M.J. Thun" 4 => "E.E. Calle" 5 => "D. Krewski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000108927.80044.7F" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2004" "volumen" => "109" "paginaInicial" => "71" "paginaFinal" => "77" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14676145" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term exposure to air pollution and incidence of cardiovascular events in women" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.A. Miller" 1 => "D.S. Siscovick" 2 => "L. Sheppard" 3 => "K. Shepherd" 4 => "J.H. Sullivan" 5 => "G.I. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa054409" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2007" "volumen" => "356" "paginaInicial" => "447" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17267905" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urban outdoor air pollution: burden of disease by country" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Global Health Observatory Data Repository" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2008" "editorial" => "World Health Organization" "editorialLocalizacion" => "Geneva" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "http://apps.who.int/gho/data/node.main.285" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fine particulate air pollution and mortality in 20 US cities, 1987–1994" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.M. Samet" 1 => "F. Dominici" 2 => "F.C. Curriero" 3 => "I. Coursac" 4 => "S.L. Zeger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200012143432401" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2000" "volumen" => "343" "paginaInicial" => "1742" "paginaFinal" => "1749" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11114312" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased particulate air pollution and the triggering of myocardial infarction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Peters" 1 => "D.W. Dockery" 2 => "J.E. Muller" 3 => "M.A. Mittleman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.cir.103.23.2810" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2001" "volumen" => "103" "paginaInicial" => "2810" "paginaFinal" => "2815" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11401937" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Economics of chronic heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Berry" 1 => "D.R. Murdoch" 2 => "J.J. McMurray" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s1388-9842(01)00123-4" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2001" "volumen" => "3" "paginaInicial" => "283" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11377998" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Davies" 1 => "F. Hobbs" 2 => "R. Davis" 3 => "J. Kenkre" 4 => "A.K. Roalfe" 5 => "R. Hare" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0140-6736(01)05620-3" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2001" "volumen" => "358" "paginaInicial" => "439" "paginaFinal" => "444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11513906" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.M. Redfield" 1 => "S.J. Jacobsen" 2 => "J.C. Burnett Jr" 3 => "D.W. Mahoney" 4 => "K.R. Bailey" 5 => "R.J. Rodeheffer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.289.2.194" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2003" "volumen" => "289" "paginaInicial" => "194" "paginaFinal" => "202" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12517230" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Llorens" 1 => "P. Javaloyes" 2 => "F.J. Martín-Sánchez" 3 => "J. Jacob" 4 => "P. Herrero-Puente" 5 => "V. Gil" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00392-018-1261-z" "Revista" => array:6 [ "tituloSerie" => "Clin Res Cardiol" "fecha" => "2018" "volumen" => "107" "paginaInicial" => "897" "paginaFinal" => "913" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29728831" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rehospitalizations among patients in the Medicare fee-for-service program" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.F. Jencks" 1 => "M.V. Williams" 2 => "E.A. Coleman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMsa0803563" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "360" "paginaInicial" => "1418" "paginaFinal" => "1428" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19339721" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998–2008" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Chen" 1 => "S.L. Normand" 2 => "Y. Wang" 3 => "H.M. Krumholz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2011.1474" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2011" "volumen" => "306" "paginaInicial" => "1669" "paginaFinal" => "1678" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22009099" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Public health importance of triggers of myocardial infarction: a comparative risk assessment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.S. Nawrot" 1 => "L. Perez" 2 => "N. Kunzli" 3 => "E. Munters" 4 => "B. Nemery" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(10)62296-9" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2011" "volumen" => "377" "paginaInicial" => "732" "paginaFinal" => "740" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21353301" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Main air pollutants and myocardial infarction: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Mustafic" 1 => "P. Jabre" 2 => "C. Caussin" 3 => "M.H. Murad" 4 => "S. Escolano" 5 => "M. Tafflet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2012.126" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2012" "volumen" => "307" "paginaInicial" => "713" "paginaFinal" => "721" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22337682" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospitalizations after heart failure diagnosis a community perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Dunlay" 1 => "M.M. Redfield" 2 => "S.A. Weston" 3 => "T.M. Therneau" 4 => "K.H. Long" 5 => "N.D. Shah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2009.08.019" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2009" "volumen" => "54" "paginaInicial" => "1695" "paginaFinal" => "1702" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19850209" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ischemic and thrombotic effects of dilute diesel-exhaust inhalation in men with coronary heart disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.L. Mills" 1 => "H. Tornqvist" 2 => "M.C. Gonzalez" 3 => "E. Vink" 4 => "S.D. Robinson" 5 => "S. Söderberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa066314" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2007" "volumen" => "357" "paginaInicial" => "1075" "paginaFinal" => "1082" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17855668" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diesel exhaust inhalation increases thrombus formation in man" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. Lucking" 1 => "M. Lundback" 2 => "N.L. Mills" 3 => "D. Faratian" 4 => "S.L. Barath" 5 => "J. Pourazar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehn464" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2008" "volumen" => "29" "paginaInicial" => "3043" "paginaFinal" => "3051" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18952612" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adverse cardiovascular effects of air pollution" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.L. Mills" 1 => "K. Donaldson" 2 => "P.W. Hadoke" 3 => "N.A. Boon" 4 => "W. MacNee" 5 => "F.R. Cassee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ncpcardio1399" "Revista" => array:6 [ "tituloSerie" => "Nat Clin Pract Cardiovasc Med" "fecha" => "2009" "volumen" => "6" "paginaInicial" => "36" "paginaFinal" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19029991" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Precipitating factors and 90-day outcome of acute heart failure: a report from the intercontinental GREAT registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Arrigo" 1 => "E. Gayat" 2 => "J. Parenica" 3 => "S. Ishihara" 4 => "J. Zhang" 5 => "D.J. Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ejhf.682" "Revista" => array:6 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2017" "volumen" => "19" "paginaInicial" => "201" "paginaFinal" => "208" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27790819" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PAPRICA-2 study: role of precipitating factor of an acute heart failure episode on intermediate term prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Miró" 1 => "A. Aguirre" 2 => "P. Herrero" 3 => "J. Jacob" 4 => "F.J. Martín-Sánchez" 5 => "P. Llorens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2015.01.014" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2015" "volumen" => "145" "paginaInicial" => "385" "paginaFinal" => "389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25817454" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seguridad e identificación de factores modificables en los pacientes mayores dados de alta desde urgencias por insuficiencia cardiaca aguda" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. García-Álvarez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2021" "volumen" => "33" "paginaInicial" => "161" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33978327" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictive risk factors for death in elderly patients after hospitalization for acute heart failure in an internal medicine unit" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Roubille" 1 => "B. Eduin" 2 => "C. Breuker" 3 => "L. Zerkowski" 4 => "S. Letertre" 5 => "C. Mercuzot" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11739-022-02982-2" "Revista" => array:6 [ "tituloSerie" => "Intern Emerg Med" "fecha" => "2022" "volumen" => "17" "paginaInicial" => "1661" "paginaFinal" => "1668" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35460014" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resultados a 30 días en los pacientes mayores frágiles con insuficiencia cardiaca aguda dados de alta desde urgencias o sus unidades vinculadas que cumplen los criterios de alto riesgo del estudio DEED FRAIL-AHF" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. Martín-Sánchez" 1 => "P. Parra Esquivel" 2 => "G. Llopis García" 3 => "J. González del Castillo" 4 => "E. Rodríguez Andrada" 5 => "B. Espinosa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2021" "volumen" => "33" "paginaInicial" => "165" "paginaFinal" => "173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33978329" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting 30-day mortality for patients with acute heart failure in the emergency department: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Ò Miró" 1 => "X. Rossello" 2 => "V. Gil" 3 => "F.J. Martín-Sánchez" 4 => "P. Llorens" 5 => "P. Herrero-Puente" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/M16-2726" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2017" "volumen" => "167" "paginaInicial" => "698" "paginaFinal" => "705" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28973663" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Características clínicas, asistenciales y evolutivas de la insuficiencia cardiaca aguda en el clima subtropical: resultados del estudio CANAR-ICA" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Benito Lozano" 1 => "O. Miró" 2 => "P. Llorens" 3 => "L. Travería" 4 => "J.M. Pavón Monzó" 5 => "A. Noval de la Torre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2021" "volumen" => "33" "paginaInicial" => "413" "paginaFinal" => "420" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34813187" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calidad del aire ambiente, inhalación de contaminantes y consultasen los servicios de urgencia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2021" "volumen" => "33" "paginaInicial" => "411" "paginaFinal" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34813186" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of meteorological temperature and pressure on the severity of heart failure decompensations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Ò Miró" 1 => "M. Benito-Lozano" 2 => "P. Lopez-Ayala" 3 => "S. Rodríguez" 4 => "P. Llorens" 5 => "A. Yufera-Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11606-022-07743-7" "Revista" => array:6 [ "tituloSerie" => "J Gen Intern Med" "fecha" => "2022" "volumen" => "38" "paginaInicial" => "600" "paginaFinal" => "609" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35941492" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ambient temperature and atmospheric pressure at discharge as precipitating factors in immediate adverse events in patients treated for decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Benito-Lozano" 1 => "P. López-Ayala" 2 => "S. Rodríguez" 3 => "V. Gil" 4 => "P. Llorens" 5 => "A. Yufera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11739-022-03078-7" "Revista" => array:6 [ "tituloSerie" => "Intern Emerg Med" "fecha" => "2022" "volumen" => "17" "paginaInicial" => "2045" "paginaFinal" => "2056" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36050571" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contaminación atmosférica urbana e ingresos hospitalarios por asma y enfermedades respiratorias agudas en la ciudad de Murcia (España)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. Ortega-García" 1 => "I. Martínez-Hernández" 2 => "E. Boldo" 3 => "A. Cárceles-Álvarez" 4 => "C. Solano-Navarro" 5 => "R. Ramis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "2020" "volumen" => "93" "paginaInicial" => "95" "paginaFinal" => "102" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does the meteorological origin of heat waves influence their impact on health? A 6-year morbidity and mortality study in Madrid (Spain)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Ruiz-Páez" 1 => "J. Díaz" 2 => "J.A. López-Bueno" 3 => "M.A. Navas" 4 => "I.J. Mirón" 5 => "G.S. Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.scitotenv.2022.158900" "Revista" => array:5 [ "tituloSerie" => "Sci Total Environ" "fecha" => "2023" "volumen" => "855" "paginaInicial" => "158900" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36155828" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Gencat. Medio ambiente y sostenibilidad. Descarga de datos automáticos [Accessed 30 March 2022]. Available from: <a target="_blank" href="https://mediambient.gencat.cat/es/05_ambits_dactuacio/atmosfera/qualitat_de_laire/vols-saber-que-respires/descarrega-de-dades/descarrega-dades-automatiques/">https://mediambient.gencat.cat/es/05_ambits_dactuacio/atmosfera/qualitat_de_laire/vols-saber-que-respires/descarrega-de-dades/descarrega-dades-automatiques/</a>." ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Portal de datos abiertos del Ayuntamiento de Madrid. Calidad del aire. Datos diarios desde 2001 [Accessed 30 March 2022]. Available from: <a target="_blank" href="https://datos.madrid.es/portal/site/egob/menuitem.c05c1f754a33a9fbe4b2e4b284f1a5a0/?vgnextoid=aecb88a7e2b73410VgnVCM2000000c205a0aRCRD%26vgnextchannel=374512b9ace9f310VgnVCM100000171f5a0aRCRD%26vgnextfmt=default">https://datos.madrid.es/portal/site/egob/menuitem.c05c1f754a33a9fbe4b2e4b284f1a5a0/?vgnextoid=aecb88a7e2b73410VgnVCM2000000c205a0aRCRD&vgnextchannel=374512b9ace9f310VgnVCM100000171f5a0aRCRD&vgnextfmt=default</a>." ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global association of air pollution and heart failure: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.S. Shah" 1 => "J.P. Langrish" 2 => "H. Nair" 3 => "D.A. McAllister" 4 => "A.L. Hunter" 5 => "K. Donaldson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(13)60898-3" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2013" "volumen" => "382" "paginaInicial" => "1039" "paginaFinal" => "1048" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23849322" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Regression modeling strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Harrell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "2nd ed." "fecha" => "2015" "editorial" => "Springer-Verlag" "editorialLocalizacion" => "New York" ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between exposure to sulphur dioxide air pollution, white cell inflammatory biomarkers and enzymatic infarct size in patients with ST-segment elevation acute coronary syndromes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Díaz-Chirón" 1 => "L. Negral" 2 => "L. Megido" 3 => "B. Suárez-Peña" 4 => "A. Domínguez-Rodríguez" 5 => "S. Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.15420/ecr.2021.37" "Revista" => array:5 [ "tituloSerie" => "Eur Cardiol" "fecha" => "2021" "volumen" => "16" "paginaInicial" => "e50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34950246" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influencia del dióxido de nitrógeno ambiental en las consultas a urgencias por asma en un entorno con baja contaminación: análisis de series temporales y casos cruzados" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Ruiz Albi" 1 => "R. López-Izquierdo" 2 => "A. Cerezo-Hernández" 3 => "F. Moreno" 4 => "P. Burgos Díez" 5 => "D. Álvarez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2021" "volumen" => "33" "paginaInicial" => "421" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34813188" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Artificial intelligence MacHIne learning for the detection and treatment of atrial fibrillation guidelines in the emergency department setting (AIM HIGHER): assessing a machine learning clinical decision support tool to detect and treat non-valvular atrial fibrillation in the emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Schwab" 1 => "D. Nguyen" 2 => "G. Ungab" 3 => "G. Feld" 4 => "A.S. Maisel" 5 => "M. Than" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/emp2.12534" "Revista" => array:5 [ "tituloSerie" => "J Am Coll Emerg Physicians Open" "fecha" => "2021" "volumen" => "2" "paginaInicial" => "e12534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34401870" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Artificial intelligence occult sepsis detection in the emergency department: a large, multicenter real-world data study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W.F. Peacock" 1 => "G.R. Hauser" 2 => "P. Toshev" 3 => "C. Colovos" 4 => "J. Tamay-Sarver" 5 => "A. Adib" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Ann Emerg Med" "fecha" => "2021" "volumen" => "78" "paginaInicial" => "S24" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of air pollution on daily hospital admissions for cardiovascular diseases in Castilla-La Mancha" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Rodríguez" 1 => "A.I. Cobo-Cuenca" 2 => "R. Quiles" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Air Qual Atmosph Health" "fecha" => "2022" "volumen" => "15" "paginaInicial" => "591" "paginaFinal" => "604" ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Organización y práctica clínica actual en los servicios de urgencias españoles en la atención a los pacientes con insuficiencia cardiaca aguda" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Miró" 1 => "C. Sánchez" 2 => "V. Gil" 3 => "D. Repullo" 4 => "E.J. García-Lamberechts" 5 => "J. González del Castillo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "2022" "volumen" => "34" "paginaInicial" => "84" "paginaFinal" => "94" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La organización asistencial de la insuficiencia cardiaca descompensada en España: ¿dónde estamos?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Lorenzo Hernández" 1 => "J. Sanchís" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2022" "volumen" => "34" "paginaInicial" => "81" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35275457" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016100000001/v2_202311101438/S2387020623002401/v2_202311101438/en/main.assets" "Apartado" => array:4 [ "identificador" => "43310" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016100000001/v2_202311101438/S2387020623002401/v2_202311101438/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623002401?idApp=UINPBA00004N"]

Statistics

Original article

Analysis of the relationship between ambient air pollution and the severity of heart failure decompensations in two Spanish metropolises (Barcelona and Madrid)

Análisis de la relación entre la contaminación del aire ambiente y la gravedad de las descompensaciones por insuficiencia cardiaca en dos metrópolis españolas (Barcelona y Madrid)

Miguel Benito-Lozanoa,1, Pedro López-Ayalab,1, Sergio Rodríguezc, Pere Llorensd, Alberto Domínguez-Rodrígueze, Alfons Aguirref, Aitor Alquézarg, Javier Jacobh, Víctor Gili, Francisco Javier Martín-Sánchezj, María Mirk, Juan Antonio Anduezal, Guillermo Burillo-Putzee,

Corresponding author

gburillo@telefonica.net

Corresponding author.

, Òscar Mirói, on behalf of the ICA-SEMES group 2

a Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain

b Cardiovascular Research Institute Basel (CRIB) and Cardiology Department, University Hospital Basel, University of Basel, Basel, Switzerland

c Instituto de Productos Naturales y Agrobiología (IPNA), CSIC, La Laguna, Santa Cruz de Tenerife, Spain

d Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain

e Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Tenerife, Spain

f Servicio de Urgencias, Hospital del Mar, Barcelona, Spain

g Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

h Servicio de Urgencias, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

i Área de Urgencias, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain

j Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain

k Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, Spain

l Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, Spain

Read

Not available

Times
was read the article

Total PDF

Total HTML

Share statistics

 array:24 [
  "pii" => "S2387020623002401"
  "issn" => "23870206"
  "doi" => "10.1016/j.medcle.2023.02.012"
  "estado" => "S300"
  "fechaPublicacion" => "2023-07-07"
  "aid" => "6219"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;. All rights reserved"
  "copyrightAnyo" => "2023"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Med Clin. 2023;161:11-9"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0025775323001434"
      "issn" => "00257753"
      "doi" => "10.1016/j.medcli.2023.02.016"
      "estado" => "S300"
      "fechaPublicacion" => "2023-07-07"
      "aid" => "6219"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Med Clin. 2023;161:11-9"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "An&#225;lisis de la relaci&#243;n entre la contaminaci&#243;n del aire ambiente y la gravedad de las descompensaciones por insuficiencia cardiaca en dos metr&#243;polis espa&#241;olas &#40;Barcelona y Madrid&#41;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "11"
            "paginaFinal" => "19"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Analysis of the relationship between ambient air pollution and the severity of heart failure decompensations in two Spanish metropolises &#40;Barcelona and Madrid&#41;"
          ]
        ]
        "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" => "fig1"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1922
                "Ancho" => 3311
                "Tamanyo" => 339814
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagrama de inclusi&#243;n de pacientes&#46; EAHFE&#58; <span class="elsevierStyleItalic">Epidemiology of Acute Heart Failure in Emergency departments&#46;</span></p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Miguel Benito-Lozano, Pedro L&#243;pez-Ayala, Sergio Rodr&#237;guez, Pere Llorens, Alberto Dom&#237;nguez-Rodr&#237;guez, Alfons Aguirre, Aitor Alqu&#233;zar, Javier Jacob, V&#237;ctor Gil, Francisco Javier Mart&#237;n-S&#225;nchez, Mar&#237;a Mir, Juan Antonio Andueza, Guillermo Burillo-Putze, &#210;scar Mir&#243;"
            "autores" => array:15 [
              0 => array:2 [
                "nombre" => "Miguel"
                "apellidos" => "Benito-Lozano"
              ]
              1 => array:2 [
                "nombre" => "Pedro"
                "apellidos" => "L&#243;pez-Ayala"
              ]
              2 => array:2 [
                "nombre" => "Sergio"
                "apellidos" => "Rodr&#237;guez"
              ]
              3 => array:2 [
                "nombre" => "Pere"
                "apellidos" => "Llorens"
              ]
              4 => array:2 [
                "nombre" => "Alberto"
                "apellidos" => "Dom&#237;nguez-Rodr&#237;guez"
              ]
              5 => array:2 [
                "nombre" => "Alfons"
                "apellidos" => "Aguirre"
              ]
              6 => array:2 [
                "nombre" => "Aitor"
                "apellidos" => "Alqu&#233;zar"
              ]
              7 => array:2 [
                "nombre" => "Javier"
                "apellidos" => "Jacob"
              ]
              8 => array:2 [
                "nombre" => "V&#237;ctor"
                "apellidos" => "Gil"
              ]
              9 => array:2 [
                "nombre" => "Francisco Javier"
                "apellidos" => "Mart&#237;n-S&#225;nchez"
              ]
              10 => array:2 [
                "nombre" => "Mar&#237;a"
                "apellidos" => "Mir"
              ]
              11 => array:2 [
                "nombre" => "Juan Antonio"
                "apellidos" => "Andueza"
              ]
              12 => array:2 [
                "nombre" => "Guillermo"
                "apellidos" => "Burillo-Putze"
              ]
              13 => array:2 [
                "nombre" => "&#210;scar"
                "apellidos" => "Mir&#243;"
              ]
              14 => array:1 [
                "colaborador" => "en representaci&#243;n del grupo ICA-SEMES"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2387020623002401"
          "doi" => "10.1016/j.medcle.2023.02.012"
          "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/S2387020623002401?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323001434?idApp=UINPBA00004N"
      "url" => "/00257753/0000016100000001/v1_202306261002/S0025775323001434/v1_202306261002/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2387020623002462"
    "issn" => "23870206"
    "doi" => "10.1016/j.medcle.2023.04.009"
    "estado" => "S300"
    "fechaPublicacion" => "2023-07-07"
    "aid" => "6250"
    "copyright" => "The Author&#40;s&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Med Clin. 2023;161:20-3"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Prevalence and impact of cerebrovascular risk factors in patients with giant cell arteritis&#58; An observational study from the Spanish national registry"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "20"
          "paginaFinal" => "23"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Prevalencia e impacto de los factores de riesgo cerebrovascular en pacientes con arteritis de c&#233;lulas gigantes&#58; un estudio observacional del registro nacional espa&#241;ol"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Enrique S&#225;nchez-Chica, Mar&#237;a Mart&#237;nez-Urbistondo, &#193;ngela Guti&#233;rrez Rojas, Raquel Castej&#243;n, Juan A&#46; Vargas-N&#250;&#241;ez, V&#237;ctor Moreno-Torres"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Enrique"
              "apellidos" => "S&#225;nchez-Chica"
            ]
            1 => array:2 [
              "nombre" => "Mar&#237;a"
              "apellidos" => "Mart&#237;nez-Urbistondo"
            ]
            2 => array:2 [
              "nombre" => "&#193;ngela"
              "apellidos" => "Guti&#233;rrez Rojas"
            ]
            3 => array:2 [
              "nombre" => "Raquel"
              "apellidos" => "Castej&#243;n"
            ]
            4 => array:2 [
              "nombre" => "Juan A&#46;"
              "apellidos" => "Vargas-N&#250;&#241;ez"
            ]
            5 => array:2 [
              "nombre" => "V&#237;ctor"
              "apellidos" => "Moreno-Torres"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623002462?idApp=UINPBA00004N"
    "url" => "/23870206/0000016100000001/v2_202311101438/S2387020623002462/v2_202311101438/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2387020623002449"
    "issn" => "23870206"
    "doi" => "10.1016/j.medcle.2023.02.013"
    "estado" => "S300"
    "fechaPublicacion" => "2023-07-07"
    "aid" => "6206"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Clin. 2023;161:1-10"
    "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" => "Improvement of left ventricular ejection fraction in patients with heart failure with reduced ejection fraction&#58; Predictors and clinical impact"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "1"
          "paginaFinal" => "10"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Impacto cl&#237;nico a medio plazo de la mejor&#237;a de la fracci&#243;n de eyecci&#243;n ventricular izquierda en pacientes con insuficiencia cardiaca con fracci&#243;n de eyecci&#243;n reducida"
        ]
      ]
      "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" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1692
              "Ancho" => 2508
              "Tamanyo" => 189516
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier curves of time to readmission for heart failure in patients with improved LVEF&#46; Estimates of the probability of hospital readmission for heart failure for patients with HFimpEF and HFsrEF and patients at risk are shown&#46; HFimpEF&#58; Heart Failure with Improved Ejection Fraction&#59; HFsrEF&#58; Heart Failure with Sustained Reduced Ejection Fraction&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jorge Perea-Armijo, Jos&#233; L&#243;pez-Aguilera, Roc&#237;o S&#225;nchez-Prats, Juan Carlos Castillo-Dom&#237;nguez, Rafael Gonz&#225;lez-Manzanares, Mart&#237;n Ruiz-Ortiz, Dolores Mesa-Rubio, Manuel Anguita-S&#225;nchez"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "Jorge"
              "apellidos" => "Perea-Armijo"
            ]
            1 => array:2 [
              "nombre" => "Jos&#233;"
              "apellidos" => "L&#243;pez-Aguilera"
            ]
            2 => array:2 [
              "nombre" => "Roc&#237;o"
              "apellidos" => "S&#225;nchez-Prats"
            ]
            3 => array:2 [
              "nombre" => "Juan Carlos"
              "apellidos" => "Castillo-Dom&#237;nguez"
            ]
            4 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Gonz&#225;lez-Manzanares"
            ]
            5 => array:2 [
              "nombre" => "Mart&#237;n"
              "apellidos" => "Ruiz-Ortiz"
            ]
            6 => array:2 [
              "nombre" => "Dolores"
              "apellidos" => "Mesa-Rubio"
            ]
            7 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Anguita-S&#225;nchez"
            ]
            8 => array:1 [
              "colaborador" => "on behalf of the working group of the Heart Failure Unit of Reina Sofia Hospital"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623002449?idApp=UINPBA00004N"
    "url" => "/23870206/0000016100000001/v2_202311101438/S2387020623002449/v2_202311101438/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Analysis of the relationship between ambient air pollution and the severity of heart failure decompensations in two Spanish metropolises &#40;Barcelona and Madrid&#41;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "11"
        "paginaFinal" => "19"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Miguel Benito-Lozano, Pedro L&#243;pez-Ayala, Sergio Rodr&#237;guez, Pere Llorens, Alberto Dom&#237;nguez-Rodr&#237;guez, Alfons Aguirre, Aitor Alqu&#233;zar, Javier Jacob, V&#237;ctor Gil, Francisco Javier Mart&#237;n-S&#225;nchez, Mar&#237;a Mir, Juan Antonio Andueza, Guillermo Burillo-Putze, &#210;scar Mir&#243;"
        "autores" => array:15 [
          0 => array:3 [
            "nombre" => "Miguel"
            "apellidos" => "Benito-Lozano"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Pedro"
            "apellidos" => "L&#243;pez-Ayala"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Sergio"
            "apellidos" => "Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Pere"
            "apellidos" => "Llorens"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Alberto"
            "apellidos" => "Dom&#237;nguez-Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Alfons"
            "apellidos" => "Aguirre"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Aitor"
            "apellidos" => "Alqu&#233;zar"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Javier"
            "apellidos" => "Jacob"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "V&#237;ctor"
            "apellidos" => "Gil"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Francisco Javier"
            "apellidos" => "Mart&#237;n-S&#225;nchez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">j</span>"
                "identificador" => "aff0050"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Mir"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">k</span>"
                "identificador" => "aff0055"
              ]
            ]
          ]
          11 => array:3 [
            "nombre" => "Juan Antonio"
            "apellidos" => "Andueza"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">l</span>"
                "identificador" => "aff0060"
              ]
            ]
          ]
          12 => array:4 [
            "nombre" => "Guillermo"
            "apellidos" => "Burillo-Putze"
            "email" => array:1 [
              0 => "gburillo@telefonica.net"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          13 => array:3 [
            "nombre" => "&#210;scar"
            "apellidos" => "Mir&#243;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          14 => array:2 [
            "colaborador" => "on behalf of the ICA-SEMES group"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">2</span>"
                "identificador" => "fn0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:12 [
          0 => array:3 [
            "entidad" => "Universidad de La Laguna&#44; La Laguna&#44; Santa Cruz de Tenerife&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Cardiovascular Research Institute Basel &#40;CRIB&#41; and Cardiology Department&#44; University Hospital Basel&#44; University of Basel&#44; Basel&#44; Switzerland"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Instituto de Productos Naturales y Agrobiolog&#237;a &#40;IPNA&#41;&#44; CSIC&#44; La Laguna&#44; Santa Cruz de Tenerife&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Urgencias&#44; Corta Estancia y Hospitalizaci&#243;n a Domicilio&#44; Hospital General Universitario Dr&#46; Balmis&#44; Instituto de Investigaci&#243;n Sanitaria y Biom&#233;dica de Alicante &#40;ISABIAL&#41;&#44; Universidad Miguel Hern&#225;ndez&#44; Alicante&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Facultad de Ciencias de la Salud&#44; Universidad Europea de Canarias&#44; La Orotava&#44; Tenerife&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Servicio de Urgencias&#44; Hospital del Mar&#44; Barcelona&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Servicio de Urgencias&#44; Hospital de la Santa Creu i Sant Pau&#44; Barcelona&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Servicio de Urgencias&#44; Hospital Universitari de Bellvitge&#44; L&#8217;Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "&#193;rea de Urgencias&#44; Hospital Cl&#237;nic&#44; Instituto de Investigaciones Biom&#233;dicas August Pi i Sunyer &#40;IDIBAPS&#41;&#44; Universitat de Barcelona&#44; Barcelona&#44; Spain"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
          9 => array:3 [
            "entidad" => "Servicio de Urgencias&#44; Hospital Cl&#237;nico San Carlos&#44; Madrid&#44; Spain"
            "etiqueta" => "j"
            "identificador" => "aff0050"
          ]
          10 => array:3 [
            "entidad" => "Servicio de Urgencias&#44; Hospital Universitario Infanta Leonor&#44; Madrid&#44; Spain"
            "etiqueta" => "k"
            "identificador" => "aff0055"
          ]
          11 => array:3 [
            "entidad" => "Servicio de Urgencias&#44; Hospital General Universitario Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "l"
            "identificador" => "aff0060"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "An&#225;lisis de la relaci&#243;n entre la contaminaci&#243;n del aire ambiente y la gravedad de las descompensaciones por insuficiencia cardiaca en dos metr&#243;polis espa&#241;olas &#40;Barcelona y Madrid&#41;"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1922
            "Ancho" => 3311
            "Tamanyo" => 334577
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient inclusion diagram&#46; EAHFE&#58; <span class="elsevierStyleItalic">Epidemiology of Acute Heart Failure in Emergency departments</span>&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Numerous epidemiological and observational studies have shown that poor air quality due to air pollutants has an impact on cardiovascular health&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> WHO estimates that ambient air pollution causes about 8 million premature deaths worldwide each year&#44; and that 40&#37; of these deaths are due to cardiovascular causes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Even brief exposures have been associated with increases in cardiovascular mortality&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> particularly in susceptible populations and those with comorbidities&#44; including cardiovascular conditions&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this regard&#44; heart failure &#40;HF&#41; is a growing public health problem affecting more than 23 million people worldwide&#44; with an increasing prevalence in older people&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> It has a high mortality&#44; which occurs especially during episodes of decompensation&#46; Thus&#44; acute HF &#40;AHF&#41; is one of the most common reasons for hospitalisation and re-hospitalisation in the elderly&#44; accounting for 5&#37; of all hospital discharge diagnoses&#46; Mortality at one year of the AHF episode is around 30&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;13</span></a> Triggers for AHF&#44; especially in susceptible individuals&#44; are therefore a major public health concern&#46; Numerous causes of decompensation&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> as well as factors associated with an increased risk of developing adverse events have been described over the past decades&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The relationship between ambient air quality and the outcome of HF patients has been less studied&#44; in contrast to the extensive knowledge on the relationship between air quality and acute cardiovascular diseases such as myocardial infarction&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;21</span></a> However&#44; the associations found between air pollution and acute coronary syndrome cannot be directly translated&#44; as there are major differences in the mechanisms that trigger myocardial infarction compared to AHF&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a> In addition&#44; much of the previous research has consisted of epidemiological studies based on time series analysis in general populations investigating the incidence of specific cardiovascular diseases&#44; including HF<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> or global or cardiovascular patterns of mortality related to environmental conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Surprisingly&#44; none have analysed the severity of decompensations and the risk of adverse events in AHF in relation to ambient air pollutants in cohorts of HF patients&#46; Therefore&#44; our aim was to investigate the relationship between air pollution and the severity of HF decompensation using a cohort of patients that included both inpatients and outpatients treated for HF decompensation&#44; i&#46;e&#46;&#44; severe and not so severe patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Scope of the study</span><p id="par0020" class="elsevierStylePara elsevierViewall">The present study is a sub-analysis of the EAHFE Registry&#46; The EAHFE Registry is a prospective&#44; multi-centre cohort study initiated in 2007&#46; Every 2&#8211;3 years it conducts a 1&#8211;2 month screening of all consecutive patients diagnosed with AHF in Spanish hospital emergency departments &#40;EDs&#41; participating in the project&#46; There is no planned intervention and patient management is based entirely on the decisions of the treating physician in the ED&#46; The only exclusion criterion is the development of AHF during ST-segment elevation myocardial infarction&#44; as many of these patients go directly to the cath lab for revascularisation&#44; bypassing the ED&#46; To date&#44; 7 screening phases have been carried out &#40;2007&#44; 2009&#44; 2011&#44; 2014&#44; 2016&#44; 2018 and 2019&#41;&#44; 45 EDs from Spanish regional and reference hospitals have participated &#40;representing around 15&#37; of the hospitals in the Spanish public health system&#41;&#44; and 19&#44;947 patients with AHF have been included&#46; The details of the dynamics of inclusion and the working protocol have been previously published&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;25&#44;26</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients diagnosed with decompensated HF in the emergency department of 4 hospitals in Barcelona &#40;Hospital Cl&#237;nic&#44; Hospital de la Santa Creu i Sant Pau&#44; Hospital del Mar and Hospital Universitari de Bellvitge&#41; and 3 in Madrid &#40;Hospital Cl&#237;nico San Carlos&#44; Hospital Universitario Gregorio Mara&#241;&#243;n and Hospital Universitario Infanta Leonor&#41; and included in the EAHFE registry during phases 2&#8211;7 &#40;in total&#44; 336 days of inclusion&#41; were included&#46; Clinical data were collected for these patients&#44; including age&#44; sex&#44; 13 comorbidities and 2 variables of their baseline functional status&#58; degree of dependency according to the Barthel index and respiratory class according to the NYHA scale&#46; In addition&#44; 2 atmospheric variables&#44; maximum daily temperature and pressure&#44; were collected&#44; which may influence the severity of decompensations&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a> Following the methodology used in other studies&#44; the atmospheric pressure was expressed as a pressure anomaly&#44; which is the difference between the maximum pressure of each day and the average maximum pressure of that city&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> This corrects for the difference in atmospheric pressure between Barcelona and Madrid due to their different altitude above sea level&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Exposure variable</span><p id="par0030" class="elsevierStylePara elsevierViewall">The air pollutant measurements were carried out by the air quality monitoring network&#44; managed by the Generalitat de Catalunya &#40;Catalonia Government&#41;&#44; the Comunidad de Madrid &#40;Madrid Community Government&#41; and the Ayuntamiento de Madrid &#40;Madrid City Council&#41;&#44; under the coordination of the Ministerio para la Transici&#243;n Ecol&#243;gica y el Reto Demogr&#225;fico &#40;Ministry for Ecological Transition and the Demographic Challenge&#41;&#46; Daily average concentrations were collected for 4 gaseous pollutants &#40;sulphur dioxide &#91;SO<span class="elsevierStyleInf">2</span>&#93;&#44; nitrogen dioxide &#91;NO<span class="elsevierStyleInf">2</span>&#93;&#44; carbon monoxide &#91;CO&#93; and ozone &#91;O<span class="elsevierStyleInf">3</span>&#93;&#41; and particulate matter smaller than 10 and 2&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;&#44; i&#46;e&#46;&#44; PM<span class="elsevierStyleInf">10</span> and PM<span class="elsevierStyleInf">2&#46;5</span>&#44; respectively&#44; on the day of the patient&#8217;s visit to ED&#46; The levels of pollutants and particulate matter on the day of the ED visit were chosen to be recorded following the methodology of similar recent studies that assess ED care in terms of environmental pollution&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The data corresponding to the hospitals in Barcelona were obtained from the data portal of the Generalitat de Catalunya&#44; in the section corresponding to environment and sustainability&#58; automatic data download&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> It contains hourly data on pollutants collected at the automatic measuring points of the Air Pollution Monitoring and Forecasting Network since 1991&#46; The Barcelona Sants and Barcelona Eixample stations were chosen because between them all pollutants were accessible throughout the study period &#40;except for PM<span class="elsevierStyleInf">2&#46;5</span> concentrations in 2009&#44; which were not recorded&#41; and because they are located in the city centre and close to the participating hospitals &#40;less than 5<span class="elsevierStyleHsp" style=""></span>km away&#41;&#46; Air quality data for hospitals in Madrid were obtained from the open data portal of the Madrid City Council&#44; under data catalogue&#58; air quality&#44; where daily data since 2001<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> can be found&#46; The measurements used were specifically those collected at the Escuelas Aguirre measurement station&#44; which had data available for all pollutants during the whole study period and is located in the centre of Madrid and close to the participating hospitals &#40;less than 5<span class="elsevierStyleHsp" style=""></span>km away&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Units are expressed in &#956;g&#47;m<span class="elsevierStyleSup">3</span> for all pollutants except CO&#44; which is expressed in mg&#47;m<span class="elsevierStyleSup">3</span>&#46; At all stations&#44; air pollutants were measured using the EU reference methods&#58; ultraviolet fluorescence &#40;SO<span class="elsevierStyleInf">2</span>&#41;&#44; chemiluminescence &#40;NO<span class="elsevierStyleInf">2</span>&#41;&#44; non-dispersive infrared absorption &#40;CO&#41;&#44; ultraviolet absorption &#40;O<span class="elsevierStyleInf">3</span>&#41; and oscillating microbalance technique converted to gravimetric equivalents &#40;PM<span class="elsevierStyleInf">10</span> and PM<span class="elsevierStyleInf">2&#44;5</span>&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Outcome variables</span><p id="par0045" class="elsevierStylePara elsevierViewall">Severity of decompensation was estimated by all-cause mortality during the 7 days following ED consultation&#44; and this was the primary outcome indicator&#46; As secondary indicators&#44; the need for admission after emergency care&#44; in-hospital mortality for hospitalised patients&#44; and prolonged hospitalisation &#40;&#62;7 days&#41; for hospitalised patients discharged alive after such hospitalisation were used&#46; To determine the occurrence of the episode&#44; medical records were reviewed or patients or their relatives were contacted by telephone when there were no clear data in the medical records or access to them was not possible&#46; Episode adjudication was done locally by the principal investigator of the centre&#44; without external review&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Qualitative data are expressed as absolute frequencies and percentages&#44; and quantitative data as medians and interquartile range &#40;IQR&#41;&#46; A two-pronged approach was used to analyse the association between severity criteria and ambient air pollutant concentrations&#46; On the one hand&#44; it was assumed that there was linearity in the relationship between them&#44; as has been the case in many of the studies published so far and in the meta-analysis published by Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> For this&#44; a logistic regression analysis was used and the increase in <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#44; with its 95&#37; confidence interval &#91;CI&#93;&#41; of episode per unit increase in pollutant was calculated&#46; This estimate was adjusted for clinical and atmospheric variables&#44; city and other pollutants studied&#46; On the other hand&#44; to avoid imposing linearity&#44; we have used a restricted cubic <span class="elsevierStyleItalic">spline</span> &#40;RCS&#41; function to model the continuous association of pollutant concentration and the primary and secondary indicators of decompensation severity&#46; Five <span class="elsevierStyleItalic">spline</span> knots were placed at the 5th&#44; 27&#46;5&#44; 50th&#44; 50th&#44; 72&#46;5 and 95th centiles of the marginal distribution of each continuous variable&#44; following Harrel&#8217;s recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> The magnitude of the effect of each contaminant unit change was assessed by logistic regression and dose-response curves were used to represent the ORs and their 95&#37; CIs&#44; adjusted for the same covariates defined for logistic regression&#46; The choice of reference pollutant concentration values for the calculation of the ORs in the dose-response plots was made on the basis of biological&#44; environmental and sample distribution criteria&#46; No replacement of missing values was carried out&#46; All hypothesis tests were 2-tailed and p-values of p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; or OR with 95&#37; CI excluding value 1&#44; were considered statistically significant&#46; Data analysis was performed with Statistical Package for Social Sciences version 23&#46;0 &#40;IBM&#44; Armonk&#44; NY&#44; USA&#41; and Stata version 16&#46;1 &#40;Stata Corp&#44; College Station&#44; TX&#44; USA&#41;&#44; and some graphs were prepared with Microsoft Office Power Point version 2019 &#40;Microsoft Corporate Office&#44; Redmond&#44; Washington&#44; USA&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical considerations</span><p id="par0055" class="elsevierStylePara elsevierViewall">The ethical principles of the Declaration of Helsinki were followed and informed consent was sought from all patients to participate in the study&#46; The EAHFE registry protocol was approved by the Clinical Research Ethics Committee of the Hospital Universitario Central de Asturias as the main committee &#40;protocols 49&#47;2010&#44; 69&#47;2011&#44; 166&#47;13&#44; 160&#47;15 and 205&#47;17&#41;&#44; and by those of the rest of the participating centres&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">5292<span class="elsevierStyleHsp" style=""></span>HF decompensations were included&#44; 3231 in Barcelona and 2061 in Madrid &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The median age of the patients was 83 years &#40;IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>76&#8211;88&#41; and 56&#37; were women&#46; Patients had many comorbidities&#44; and more than half had hypertension&#44; previous HF decompensations&#44; dyslipidaemia and atrial fibrillation &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; As regards their baseline status&#44; 22&#46;4&#37; were in NYHA respiratory class <span class="elsevierStyleSmallCaps">iii</span>&#8211;<span class="elsevierStyleSmallCaps">iv</span> and 61&#44;9&#37; had some degree of dependency &#40;Barthel index<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>100 points&#41;&#44; which was severe or absolute in 15&#46;6&#37; of cases &#40;Barthel<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60 points&#41;&#46; The median &#40;IQR&#41; daily average pollutant concentrations were&#58; SO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;1&#44;4&#8211;7&#44;0&#41;&#44; NO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;34&#8211;57&#41;&#44; CO<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;48<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">3</span> &#40;0&#44;35&#8211;0&#44;63&#41;&#44; O<span class="elsevierStyleInf">3</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;25&#8211;48&#41;&#44; PM<span class="elsevierStyleInf">10</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;15&#8211;31&#41; y PM<span class="elsevierStyleInf">2&#44;5</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;8&#8211;17&#41;&#46; The distribution of these daily mean concentrations on the study days is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; The number of missing data was less than 1&#37; for most of the variables collected&#44; and none of them exceeded 10&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Seven-day mortality was 3&#46;9&#37;&#44; and hospitalisation&#44; in-hospital mortality and prolonged hospitalisation were 78&#46;9&#44; 6&#46;9 and 47&#46;5&#37;&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; No environmental pollutant showed a significant linear association with severity indicators&#44; with the exception of the direct relationship between SO<span class="elsevierStyleInf">2</span> concentration and need for hospitalisation &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;04&#44; 95&#37; CI 1&#46;01&#8211;1&#46;08&#59; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; All other associations were very close to zero&#44; and only CO concentration showed a tendency to be associated with 7-day mortality &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;04&#44; 95&#37; CI 0&#46;97&#8211;1&#46;10&#41; or in-hospital mortality &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;03&#44; 95&#37; CI 0&#46;98&#8211;1&#46;08&#59; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The study using RCS curves also showed no clear associations between pollutant concentration and severity of decompensation &#40;Appendix B &#8212; Supplementary Fig&#46;&#41;&#46; The specific analysis of the relationship between SO<span class="elsevierStyleInf">2</span> concentration and need for hospitalisation showed association starting at concentrations of 15<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;OR of 1&#46;55 compared to the reference concentration of 5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#44; 95&#37; CI 1&#46;01&#8211;2&#46;36&#41; and rising with increasing concentrations&#44; reaching an OR of 2&#46;71 for a concentration of 24<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;95&#37; CI 1&#46;13&#8211;6&#46;49&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Dose-response curves for the relationship between CO and mortality showed no associations &#40;Appendix B Supplementary Fig&#46;&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Air pollution is increasingly recognised as an important and modifiable determinant of cardiovascular disease in urban communities&#46; Acute exposure has been associated with a variety of adverse cardiovascular events&#44; including hospital admissions with angina&#44; myocardial infarction and HF&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Air pollution has a strong temporal association with HF hospitalisation and mortality&#46; Although more studies in developing countries are needed to confirm the findings of studies conducted mostly in developed countries&#44; air pollution is a widespread public health problem with important cardiovascular and health economic consequences and should remain a key target for global health policy&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The present study found no overall significant association between air pollutants and severity of decompensation in a cohort of HF patients&#46; We have only identified some association between the need for hospitalisation and SO<span class="elsevierStyleInf">2</span> concentrations&#44; with an OR of 1&#46;04 for hospitalisation per each &#956;g&#47;m<span class="elsevierStyleSup">3</span> unit increase in SO<span class="elsevierStyleInf">2</span>&#46; The apparent relationship between CO and mortality found in the linear model was not confirmed in the RCS analysis&#46; These relatively neutral findings contrast with previous studies that have shown a relationship between pollution and the number of hospitalisations and HF deaths&#46; Specifically&#44; the meta-analysis by Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> showed that HF hospitalisation was associated with all pollutants analysed in our study&#44; and HF mortality with all but CO and PM<span class="elsevierStyleInf">10</span>&#46; In their study&#44; the magnitudes of the associations ranged from 1 to 3&#37; increments for each unit increase in pollutant&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Possible reasons for this discrepancy include the fact that pollution in Barcelona and Madrid was not very high in the periods analysed&#46; Thus&#44; analysing the pollutant distributions&#44; the median &#40;IQR&#41; of the daily pollutant averages were&#58; SO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;1&#44;4&#8211;7&#44;0&#41;&#44; NO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;34&#8211;57&#41;&#44; CO<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;48<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">3</span> &#40;0&#44;35&#8211;0&#44;63&#41;&#44; O<span class="elsevierStyleInf">3</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;25&#8211;48&#41;&#44; PM<span class="elsevierStyleInf">10</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;15&#8211;31&#41; and PM<span class="elsevierStyleInf">2&#44;5</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;8&#8211;17&#41;&#46; In this sense&#44; when analysing the data in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#44; the only pollutant that shows relatively high levels &#40;and not very high&#41; is SO<span class="elsevierStyleInf">2</span>&#44; precisely the only one that showed some association with the severity of decompensation&#44; and specifically with the need for hospitalisation&#46; The rest of the pollutants show rather low values during all study days&#44; indicating that the lack of association with these other pollutants may have been because there was no record of days with high concentrations of these other pollutants&#46; Alternatively&#44; or in addition&#44; it could be that estimation in the form of daily averages may not have captured peaks of maximum pollution&#44; which may last only a few hours&#46; Finally&#44; it is possible that the effects of pollution on patients with chronic diseases&#44; such as HF&#44; may be cumulative over days&#44; and a point estimate may not allow a significant association to be found&#46; In this respect&#44; we should be cautious&#44; as our study design only shows an absence of evidence and does not confirm an absence of effect of the pollutant on the severity of AHF decompensation&#46; The study by D&#237;az-Chir&#243;n et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> which related the size of the infarct area in patients with acute coronary syndrome to the concentration of SO<span class="elsevierStyleInf">2</span>&#44; NO<span class="elsevierStyleInf">2</span>&#44; CO&#44; O<span class="elsevierStyleInf">3</span>&#44; benzene&#44; toluene&#44; xylene and particulate matter in 216 patients in Asturias&#44; only found a relationship in the multivariate analysis with SO<span class="elsevierStyleInf">2</span> levels&#46; However&#44; that study used a 7-day lag in the environmental data prior to the cardiovascular event&#46; Along the same lines&#44; the only noteworthy relationship in our study is precisely the one established between SO2 and the need for hospitalisation&#46; Hospitalisation is a sensitive marker of the effects of pollution as a trigger for acute processes&#44; such as acute asthma episodes&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> AHF is also among these processes&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">We found no association with mortality either at 7 days &#40;primary study indicator&#41; or during hospitalisation &#40;in-hospital&#41;&#46; In this case&#44; it is possible that since the study only recorded all-cause mortality&#44; without distinguishing between cardiovascular and non-cardiovascular causes of death&#44; it cannot be compared with previous studies&#46; A more detailed analysis of the causes of death could have helped to better explain the true cardiovascular effect of the ambient air pollutants studied&#46; However&#44; we should be cautious as our study only shows an absence of evidence and does not confirm evidence of no effect of most pollutants on the severity of AHF decompensation&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Finally&#44; our study underlines the importance of a more flexible and dynamic analysis of the relationship between a continuous variable&#44; such as pollutant concentration&#44; and an outcome&#46; Indeed&#44; the assumption of a linear relationship between them may ignore important relationships between disease&#44; physiology and prognosis&#46; This can be seen in our study&#44; which&#44; when using RCS-based models&#44; provided more detailed data on the associations between pollutants and severity of decompensation &#40;in particular SO<span class="elsevierStyleInf">2</span> and hospitalisation&#41;&#46; Therefore&#44; there is an opportunity for artificial intelligence applications&#44; some of which have been shown to perform better on such variables&#44; whereby this same technology could offer solutions for the analysis between environmental variables and health outcomes in both healthy and chronically ill populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#44;39</span></a></p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limitations</span><p id="par0100" class="elsevierStylePara elsevierViewall">Firstly&#44; several confounding factors make it difficult to study ambient air pollution-related morbidity and mortality&#46; Although daily atmospheric temperature and pressure were taken into account&#44; other conditions such as wind&#44; humidity or trends in changes over the immediately preceding or following days were not included in our models&#46; In this sense&#44; the analysis of the average pollution values on the days prior to the ED consultation could perhaps have yielded a different result&#46; However&#44; Rodr&#237;guez et al&#46; showed that admissions for cardiovascular disease in Castilla-La Mancha were not related to the concentration of PM<span class="elsevierStyleInf">2&#46;5</span>&#44; PM<span class="elsevierStyleInf">10</span> and NO<span class="elsevierStyleInf">2</span> and daily cardiovascular hospitalisations even considering an exposure period of up to 7 days prior to emergency department care&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> Second&#44; some pollutants&#44; such as ozone&#44; have a strong seasonal cycle&#44; with high levels in summer and low levels in the other seasons&#44; especially in winter&#46; Our study did not include the summer season and most days were winter days&#44; so this may have influenced our inability to demonstrate an association for this pollutant&#46; Third&#44; this study was carried out in the urban areas of Barcelona and Madrid&#44; and not all pollutants reach their highest concentrations in these areas&#46; Thus&#44; ozone is often elevated in rural areas on a regional level because its reaction with fresh nitric oxide from vehicle exhaust emissions leads to its titration&#46; In addition&#44; and in comparison with other studies&#44; the pollution values on the days studied were not excessively high&#46; This may have limited the number of positive associations found between contaminants and severity of AHF decompensation&#46; Fourth&#44; although the sample was large&#44; some estimates may have been subject to a type-II error&#44; as no sample size calculation was performed&#46; Therefore&#44; the lack of statistical significance should be interpreted as &#8220;no evidence&#8221; rather than &#8220;evidence of absence&#8221; of a relationship between pollution and severity of AHF episode&#46; Fifth&#44; since there was no replacement of missing values&#44; there may have been a bias in the event that the loss of values did not occur by chance&#44; which we are unable to determine&#46; Sixth&#44; the adjudication of the results was carried out at the local level&#46; However&#44; we use easily identifiable and unambiguous results to overcome the need for external adjudication&#46; Seventh&#44; although performed in a single country&#44; the organisation of care for HF patients is not uniform in all Spanish territories&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">41&#44;42</span></a> and different strategies for patient hospitalisation may affect the results&#46; On the other hand&#44; Spain has a national public health system that may impact on health outcomes in a different way than other systems&#44; so external validation is necessary prior to the generalisation of these results&#46; Eighth&#44; measurements of pollutants and particulate matter in the hospital area may not reflect the reality of exposure for a number of patients whose residence is far away from the hospital&#46; However&#44; the health policy in Barcelona and Madrid is that each patient is treated in his or her reference hospital&#44; a fact that is fulfilled in a high percentage of cases&#44; and therefore we believe that measurements in the hospital area can be very close to those of the patient&#8217;s home area in most cases&#46; Finally&#44; since this study was conducted in a real-life registry setting&#44; it included a high percentage of elderly patients with AHF &#40;who are usually excluded from clinical trials&#41;&#44; predominantly with preserved ejection fraction&#44; in whom frailty and dependency are common&#44; and these are 2 factors strongly related to mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Ambient air pollutants are not clearly related to the severity of HF decompensations in cities with moderate concentrations of ambient air pollutants&#44; such as those recorded in the present study in Barcelona and Madrid during the period 2007&#8211;2019&#46; Only an association between increased SO<span class="elsevierStyleInf">2</span> concentration and the need for HF hospitalisation was observed&#46; Further studies analysing the relationship between ambient air pollutants and the severity of HF decompensation&#44; with the help of artificial intelligence applications&#44; would be needed&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">This work was made possible in part by grants from the Instituto de Salud Carlos III with funding from the <span class="elsevierStyleGrantSponsor" id="gs0005">Ministry of Health and FEDER</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs0005">PI15&#47;01019</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs0005">PI18&#47;00393</span>&#41;&#44; <span class="elsevierStyleGrantSponsor" id="gs0010">La Marat&#243; de TV3</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs0010">2015</span>&#47;<span class="elsevierStyleGrantNumber" refid="gs0010">2510</span>&#41; and the <span class="elsevierStyleGrantSponsor" id="gs0015">Generalitat de Catalunya</span> for consolidated research groups &#40;GRC <span class="elsevierStyleGrantNumber" refid="gs0015">2009&#47;1385</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs0015">2014&#47;0313</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs0015">2017&#47;1424</span>&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest with respect to this study&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres2008320"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objectives"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Method"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1720688"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres2008321"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivos"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todo"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1720689"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Method"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Scope of the study"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Study design"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Exposure variable"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Outcome variables"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Statistical analysis"
            ]
            5 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Ethical considerations"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Results"
        ]
        7 => array:3 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Limitations"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conflict of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-12-19"
    "fechaAceptado" => "2023-02-26"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1720688"
          "palabras" => array:4 [
            0 => "Acute heart failure"
            1 => "Contamination"
            2 => "Mortality"
            3 => "Emergency Department"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1720689"
          "palabras" => array:4 [
            0 => "Insuficiencia cardiaca aguda"
            1 => "Contaminaci&#243;n del aire ambiente"
            2 => "Mortalidad"
            3 => "Servicios de urgencias"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To analyze whether the high levels of air pollutants are related to a greater severity of decompensated heart failure &#40;HF&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Patients diagnosed with decompensated HF in the emergency department of 4 hospitals in Barcelona and 3 in Madrid were included&#46; Clinical data &#40;age&#44; sex&#44; comorbidities&#44; baseline functional status&#41;&#44; atmospheric &#40;temperature&#44; atmospheric pressure&#41; and pollutant data &#40;SO<span class="elsevierStyleInf">2</span>&#44; NO<span class="elsevierStyleInf">2</span>&#44; CO&#44; O<span class="elsevierStyleInf">3</span>&#44; PM<span class="elsevierStyleInf">10</span>&#44; PM<span class="elsevierStyleInf">2&#46;5</span>&#41; were collected in the city on the day of emergency care&#46; The severity of decompensation was estimated using 7-day mortality &#40;primary indicator&#41; and the need for hospitalization&#44; in-hospital mortality&#44; and prolonged hospitalization &#40;secondary indicators&#41;&#46; The association adjusted for clinical&#44; atmospheric and city data between pollutant concentration and severity was investigated using linear regression &#40;linearity assumption&#41; and restricted cubic spline curves &#40;no linearity assumption&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A total of 5292 decompensations were included&#44; with a median age of 83 years &#40;IQR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>76&#8211;88&#41; and 56&#37; women&#46; The medians &#40;IQR&#41; of the daily pollutant averages were&#58; SO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;1&#46;4&#8211;7&#46;0&#41;&#44; NO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;34&#8211;57&#41;&#44; CO<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;48<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">3</span> &#40;0&#46;35&#8211;0&#46;63&#41;&#44; O<span class="elsevierStyleInf">3</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;25&#8211;48&#41;&#44; PM<span class="elsevierStyleInf">10</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;15&#8211;31&#41; and PM<span class="elsevierStyleInf">2&#46;5</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;8&#8211;17&#41;&#46; Mortality at 7 days was 3&#46;9&#37;&#44; and hospitalization&#44; in-hospital mortality&#44; and prolonged hospitalization were 78&#46;9&#44; 6&#46;9&#44; and 47&#46;5&#37;&#44; respectively&#46; SO<span class="elsevierStyleInf">2</span> was the only pollutant that showed a linear association with the severity of decompensation&#44; since each unit of increase implied an OR for the need for hospitalization of 1&#46;04 &#40;95&#37; CI 1&#46;01&#8211;1&#46;08&#41;&#46; The restricted cubic spline curves study also did not show clear associations between pollutants and severity&#44; except for SO<span class="elsevierStyleInf">2</span> and hospitalization&#44; with OR of 1&#46;55 &#40;95&#37; CI 1&#46;01&#8211;2&#46;36&#41; and 2&#46;71 &#40;95&#37; CI 1&#46;13&#8211;6&#46;49&#41; for concentrations of 15 and 24<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#44; respectively&#44; in relation to a reference concentration of 5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Exposure to ambient air pollutants&#44; in a medium to low concentration range&#44; is generally not related to the severity of HF decompensations&#44; and only SO<span class="elsevierStyleInf">2</span> may be associated with an increased need for hospitalization&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Analizar si la exposici&#243;n a contaminantes del aire en 2 grandes ciudades espa&#241;olas est&#225; relacionada con la gravedad de las descompensaciones de la insuficiencia cardiaca &#40;IC&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se estudiaron pacientes con IC descompensada en urgencias de 4 hospitales de Barcelona y 3 de Madrid&#46; Se recogieron datos cl&#237;nicos &#40;edad&#44; sexo&#44; comorbilidades&#44; situaci&#243;n funcional basal&#41;&#44; atmosf&#233;ricos &#40;temperatura&#44; presi&#243;n atmosf&#233;rica&#41; y de contaminantes &#40;SO<span class="elsevierStyleInf">2</span>&#44; NO<span class="elsevierStyleInf">2</span>&#44; CO&#44; O<span class="elsevierStyleInf">3</span>&#44; PM<span class="elsevierStyleInf">10</span>&#44; PM<span class="elsevierStyleInf">2&#44;5</span>&#41; el d&#237;a de atenci&#243;n en urgencias&#46; La gravedad de la descompensaci&#243;n se estim&#243; mediante la mortalidad a 7 d&#237;as &#40;indicador primario&#41; y la necesidad de hospitalizaci&#243;n&#44; mortalidad intrahospitalaria y hospitalizaci&#243;n prolongada &#40;indicadores secundarios&#41;&#46; Se investig&#243; la asociaci&#243;n ajustada por datos cl&#237;nicos&#44; atmosf&#233;ricos y ciudad entre concentraci&#243;n de contaminantes y gravedad&#44; mediante regresi&#243;n log&#237;stica &#40;asunci&#243;n de linealidad&#41; y curvas <span class="elsevierStyleItalic">spline</span> c&#250;bicas restringidas &#40;no asunci&#243;n de linealidad&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 5&#46;292 descompensaciones&#44; con edad mediana de 83 a&#241;os &#40;RIC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>76&#8211;88&#41; y 56&#37; mujeres&#46; Las medianas &#40;RIC&#41; de los promedios diarios de contaminantes fueron&#58; SO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;1&#44;4&#8211;7&#44;0&#41;&#44; NO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;34&#8211;57&#41;&#44; CO<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;48<span class="elsevierStyleHsp" style=""></span>mg&#47;m<span class="elsevierStyleSup">3</span> &#40;0&#44;35&#8211;0&#44;63&#41;&#44; O<span class="elsevierStyleInf">3</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;25&#8211;48&#41;&#44; PM<span class="elsevierStyleInf">10</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;15&#8211;31&#41; y PM<span class="elsevierStyleInf">2&#44;5</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span> &#40;8&#8211;17&#41;&#46; La mortalidad a 7 d&#237;as fue del 3&#44;9&#37;&#44; y la hospitalizaci&#243;n&#44; la mortalidad intrahospitalaria y la hospitalizaci&#243;n prolongada&#44; del 78&#44;9&#44; 6&#44;9 y 47&#44;5&#37;&#44; respectivamente&#46; El SO<span class="elsevierStyleInf">2</span> fue el &#250;nico contaminante que mostr&#243; asociaci&#243;n lineal con la gravedad de la descompensaci&#243;n&#44; ya que cada unidad de incremento supuso una OR para necesidad de hospitalizaci&#243;n de 1&#44;04 &#40;IC 95&#37; 1&#44;01&#8211;1&#44;08&#41;&#46; El estudio mediante curvas <span class="elsevierStyleItalic">spline</span> c&#250;bicas restringidas tampoco mostr&#243; asociaciones n&#237;tidas entre contaminantes y gravedad&#44; excepto para SO<span class="elsevierStyleInf">2</span> y hospitalizaci&#243;n&#44; con OR de 1&#44;55 &#40;IC 95&#37; 1&#44;01&#8211;2&#44;36&#41; y de 2&#44;71 &#40;IC 95&#37; 1&#44;13&#8211;6&#44;49&#41; para concentraciones de 15 y 24<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#44; respectivamente&#44; en relaci&#243;n con una concentraci&#243;n de referencia de 5<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;m<span class="elsevierStyleSup">3</span>&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La exposici&#243;n a contaminantes del aire ambiente&#44; en un rango de concentraciones medio a bajo&#44; en general no est&#225; relacionado con la gravedad de las descompensaciones de la IC&#44; y solo el SO<span class="elsevierStyleInf">2</span> podr&#237;a estar asociado a una mayor necesidad de hospitalizaci&#243;n&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Both authors had the same contribution to the article and both should be considered as first authors&#46;</p>"
        "identificador" => "fn0005"
      ]
      1 => array:3 [
        "etiqueta" => "2"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The names of the components of the ICA-SEMES group are listed in <a class="elsevierStyleCrossRef" href="#sec0075">Appendix A</a>&#46;</p>"
        "identificador" => "fn0010"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:2 [
          0 => array:4 [
            "apendice" => "<p id="par0120" class="elsevierStylePara elsevierViewall">Marta Fuentes&#44; Cristina Gil &#40;Hospital Universitario de Salamanca&#41;&#44; H&#233;ctor Alonso&#44; Enrique P&#233;rez-Llantada &#40;Hospital Marqu&#233;s de Valdecilla de Santander&#41;&#44; Francisco Javier Mart&#237;n-S&#225;nchez&#44; Guillermo Llopis Garc&#237;a&#44; Mar Su&#225;rez Cadenas &#40;Hospital Cl&#237;nico San Carlos de Madrid&#41;&#44; &#210;scar Mir&#243;&#44; V&#237;ctor Gil&#44; Rosa Escoda&#44; Sira Aguil&#243;&#44; Carolina S&#225;nchez &#40;Hospital Cl&#237;nic de Barcelona&#41;&#44; Carmen Gargallo &#40;Hospital Polit&#233;cnic La Fe de Valencia&#41;&#44; Jos&#233; Pav&#243;n &#40;Hospital Dr&#46; Negr&#237;n de Las Palmas de Gran Canaria&#41;&#44; Antonio Noval &#40;Hospital Insular de Las Palmas de Gran Canaria&#41;&#44; Mar&#237;a Luisa L&#243;pez-Grima&#44; Amparo Valero&#44; Mar&#237;a &#193;ngeles Juan &#40;Hospital Dr&#46; Peset de Valencia&#41;&#44; Alfons Aguirre&#44; Maria Angels Pedragosa&#44; Silvia M&#237;nguez Mas&#243; &#40;Hospital del Mar de Barcelona&#41;&#44; Mar&#237;a Isabel Alonso&#44; Francisco Ruiz &#40;Hospital de Valme de Sevilla&#41;&#44; Jos&#233; Miguel Franco &#40;Hospital Miguel Servet de Zaragoza&#41;&#44; Ana Bel&#233;n Mecina &#40;Hospital de Alcorc&#243;n&#44; Madrid&#41;&#44; Josep Tost&#44; Marta Berenguer&#44; Ruxandra Donea &#40;Consorci Sanitari de Terrassa&#44; Barcelona&#41;&#44; Susana S&#225;nchez Ram&#243;n&#44; Virginia Carbajosa Rodr&#237;guez &#40;Hospital Universitario R&#237;o Hortega de Valladolid&#41;&#44; Pascual Pi&#241;era&#44; Jos&#233; Andr&#233;s S&#225;nchez Nicol&#225;s &#40;Hospital Reina Sof&#237;a de Murcia&#41;&#44; Raquel Torres Garate &#40;Hospital Severo Ochoa de Madrid&#41;&#44; Aitor Alqu&#233;zar-Arb&#233;&#44; Miguel Alberto Rizzi&#44; Sergio Herrera &#40;Hospital de la Santa Creu i Sant Pau de Barcelona&#41;&#44; Javier Jacob&#44; Alex Roset&#44; Irene Cabello&#44; Antonio Haro &#40;Hospital Universitari de Bellvitge de Barcelona&#41;&#44; Fernando Richard&#44; Jos&#233; Mar&#237;a &#193;lvarez P&#233;rez&#44; Mar&#237;a Pilar L&#243;pez Diez &#40;Hospital Universitario de Burgos&#41;&#44; Pablo Herrero Puente&#44; Joaqu&#237;n V&#225;zquez &#193;lvarez&#44; Bel&#233;n Prieto Garc&#237;a&#44; Mar&#237;a Garc&#237;a Garc&#237;a&#44; Marta S&#225;nchez Gonz&#225;lez &#40;Hospital Universitario Central de Asturias&#44; Oviedo&#41;&#44; Pere Llorens&#44; Patricia Javaloyes&#44; Inmaculada Jim&#233;nez&#44; N&#233;stor Hern&#225;ndez&#44; Bego&#241;a Espinosa&#44; Adriana Gil&#44; Francisca Molina&#44; Tamara Garc&#237;a &#40;Hospital General de Alicante&#41;&#44; Juan Antonio Andueza &#40;Hospital General Universitario Gregorio Mara&#241;&#243;n de Madrid&#41;&#44; Rodolfo Romero &#40;Hospital Universitario de Getafe&#44; Madrid&#41;&#44; Mart&#237;n Ru&#237;z&#44; Roberto Calvache &#40;Hospital del Henares de Coslada&#44; Madrid&#41;&#44; Mar&#237;a Teresa Lorca Serralta&#44; Luis Ernesto Calder&#243;n Jave &#40;Hospital del Tajo de Aranjuez&#44; Madrid&#41;&#44; Beatriz Amores Arriaga&#44; Beatriz Sierra Bergua &#40;Hospital Cl&#237;nico Lozano Blesa de Zaragoza&#41;&#44; Enrique Mart&#237;n Mojarro&#44; Brigitte Silvana Alarc&#243;n Jim&#233;nez &#40;Hospital Sant Pau i Santa Tecla de Tarragona&#41;&#44; Lisette Traver&#237;a B&#233;cquer&#44; Guillermo Burillo &#40;Hospital Universitario de Canarias de La Laguna&#44; Tenerife&#41;&#44; Llu&#237;s Llauger Garc&#237;a&#44; Gerard Corominas LaSalle &#40;Hospital Universitari de Vic&#44; Barcelona&#41;&#44; Carmen Ag&#252;era Urbano&#44; Ana Bel&#233;n Garc&#237;a Soto&#44; Elisa Delgado Padial &#40;Hospital Costa del Sol de Marbella&#44; M&#225;laga&#41;&#44; Ester Soy Ferrer&#44; Mar&#237;a Adroher Mu&#241;oz &#40;Hospital Josep Trueta de Girona&#41;&#44; Jos&#233; Manuel Garrido &#40;Hospital Virgen Macarena de Sevilla&#41;&#44; Francisco Javier Lucas-Imbern&#243;n &#40;Hospital General Universitario de Albacete&#41;&#44; Rut Gaya &#40;Hospital Juan XXIII de Marbella&#44; M&#225;laga&#41;&#44; Francisco Javier Lucas-Imbern&#243;n &#40;Hospital General Universitario de Albacete&#41;&#44; Rut Gaya &#40;Hospital Juan XXIII de Tarragona&#41;&#44; Carlos Bibiano&#44; Mar&#237;a Mir&#44; Beatriz Rodr&#237;guez &#40;Hospital Infanta Leonor de Madrid&#41;&#44; Jos&#233; Luis Carballo &#40;Complejo Hospitalario Universitario de Ourense&#41;&#44; Esther Rodr&#237;guez-Adrada&#44; Bel&#233;n Rodr&#237;guez Miranda&#44; Monika Vicente Mart&#237;n &#40;Hospital Rey Juan Carlos de M&#243;stoles&#44; Madrid&#41;&#46; Pere Coma Casanova&#44; Joan Espinach Alvar&#243;s &#40;Hospital Sant Joan de D&#233;u de Martorell&#44; Barcelona&#41;&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Researchers of the AHF-SEMES group"
            "identificador" => "sec0075"
          ]
          1 => array:4 [
            "apendice" => "<p id="par0130" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix B"
            "titulo" => "Supplementary data"
            "identificador" => "sec0085"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1922
            "Ancho" => 3311
            "Tamanyo" => 334577
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient inclusion diagram&#46; EAHFE&#58; <span class="elsevierStyleItalic">Epidemiology of Acute Heart Failure in Emergency departments</span>&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1841
            "Ancho" => 3258
            "Tamanyo" => 330566
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Distribution of daily mean ambient air pollutant concentrations on the study days&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2869
            "Ancho" => 3167
            "Tamanyo" => 642381
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adjusted analysis of the association between the different pollutants analysed in this study and markers of heart failure decompensation severity&#46; CI&#58; confidence interval&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Fig&#46; 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1917
            "Ancho" => 3175
            "Tamanyo" => 305059
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0045"
            "detalle" => "Fig&#46; "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Adjusted dose-response curve constructed using a restricted cubic spline curve showing the odds ratio &#40;OR&#41; &#40;with 95&#37; confidence interval &#91;95&#37; CI&#93;&#41; of the pollutant &#40;SO<span class="elsevierStyleInf">2</span>&#41; that in the linear association study showed a direct association with one of the severity indicators &#40;need for hospitalisation&#41;&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0050"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">NYHA&#58; <span class="elsevierStyleItalic">New York Heart Association&#59;</span> IQR&#58; interquartile range&#46;</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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Total &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5292&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Missing values&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Demographic data</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Age &#40;years&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;76&#8722;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;970 &#40;56&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;517 &#40;85&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Previous heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;301 &#40;65&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">249 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyslipidaemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;827 &#40;53&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;718 &#40;51&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;0&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;117 &#40;41&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic Kidney Disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;614 &#40;30&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heart valve disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;547 &#40;29&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ischemic heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;514 &#40;28&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Chronic obstructive pulmonary disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;251 &#40;23&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;0&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neoplasm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">815 &#40;16&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">374 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cerebrovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">757 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Peripheral artery disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">619 &#40;11&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">565 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">376 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Functional capacity</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Barthel Index &#40;points&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;70&#8722;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">342 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NYHA class III&#8211;IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;138 &#40;22&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">203 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Atmospheric conditions</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maximum temperature&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;6 &#40;13&#46;2&#8211;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maximum atmospheric pressure anomaly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;&#8722;4&#46;8 to 5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Daily average concentration of pollutants</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sulphur dioxide &#40;SO<span class="elsevierStyleInf">2</span>&#41;&#44; &#956;g&#47;m<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5 &#40;1&#46;4&#8211;7&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nitrogen dioxide &#40;NO<span class="elsevierStyleInf">2</span>&#41;&#44; &#956;g&#47;m<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;34&#8211;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Carbon monoxide &#40;CO&#41;&#44; mg&#47;m<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;49 &#40;0&#46;35&#8211;0&#46;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;0&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ozone &#40;O<span class="elsevierStyleInf">3</span>&#41;&#44; &#956;g&#47;m<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4&#95;&#34;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;24&#8211;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Particulate matter<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>&#956; in diameter &#40;PM<span class="elsevierStyleInf">10</span>&#41;&#44; &#956;g&#47;m<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;15&#8211;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Particulate matter<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2&#44;5<span class="elsevierStyleHsp" style=""></span>&#956; in diameter &#40;PM<span class="elsevierStyleInf">2&#44;5</span>&#41;&#44; &#956;g&#47;m<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;8&#8722;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">256 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3334765.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Characteristics of patients included in the study&#46;</p>"
        ]
      ]
      5 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.doc"
          "ficheroTamanyo" => 257070
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:42 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An association between air pollution and mortality in six US cities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;W&#46; Dockery"
                            1 => "C&#46;A&#46; Pope 3rd"
                            2 => "X&#46; Xu"
                            3 => "J&#46;D&#46; Spengler"
                            4 => "J&#46;H&#46; Ware"
                            5 => "M&#46;E&#46; Fay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM199312093292401"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1993"
                        "volumen" => "329"
                        "paginaInicial" => "1753"
                        "paginaFinal" => "1759"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8179653"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between mortality and indicators of traffic-related air pollution in the Netherlands&#58; a cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Hoek"
                            1 => "B&#46; Brunekreef"
                            2 => "S&#46; Goldbohm"
                            3 => "P&#46; Fischer"
                            4 => "P&#46;A&#46; van den Brandt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(02)11280-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2002"
                        "volumen" => "360"
                        "paginaInicial" => "1203"
                        "paginaFinal" => "1209"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12401246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiovascular mortality and long-term exposure to particulate air pollution&#58; epidemiological evidence of general pathophysiological pathways of disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;A&#46; Pope 3rd"
                            1 => "R&#46;T&#46; Burnett"
                            2 => "G&#46;D&#46; Thurston"
                            3 => "M&#46;J&#46; Thun"
                            4 => "E&#46;E&#46; Calle"
                            5 => "D&#46; Krewski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.CIR.0000108927.80044.7F"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2004"
                        "volumen" => "109"
                        "paginaInicial" => "71"
                        "paginaFinal" => "77"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14676145"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term exposure to air pollution and incidence of cardiovascular events in women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;A&#46; Miller"
                            1 => "D&#46;S&#46; Siscovick"
                            2 => "L&#46; Sheppard"
                            3 => "K&#46; Shepherd"
                            4 => "J&#46;H&#46; Sullivan"
                            5 => "G&#46;I&#46; Anderson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa054409"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2007"
                        "volumen" => "356"
                        "paginaInicial" => "447"
                        "paginaFinal" => "458"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17267905"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Urban outdoor air pollution&#58; burden of disease by country"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Global Health Observatory Data Repository"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2008"
                        "editorial" => "World Health Organization"
                        "editorialLocalizacion" => "Geneva"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;apps&#46;who&#46;int&#47;gho&#47;data&#47;node&#46;main&#46;285"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fine particulate air pollution and mortality in 20 US cities&#44; 1987&#8211;1994"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;M&#46; Samet"
                            1 => "F&#46; Dominici"
                            2 => "F&#46;C&#46; Curriero"
                            3 => "I&#46; Coursac"
                            4 => "S&#46;L&#46; Zeger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM200012143432401"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2000"
                        "volumen" => "343"
                        "paginaInicial" => "1742"
                        "paginaFinal" => "1749"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11114312"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased particulate air pollution and the triggering of myocardial infarction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Peters"
                            1 => "D&#46;W&#46; Dockery"
                            2 => "J&#46;E&#46; Muller"
                            3 => "M&#46;A&#46; Mittleman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.cir.103.23.2810"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2001"
                        "volumen" => "103"
                        "paginaInicial" => "2810"
                        "paginaFinal" => "2815"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11401937"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Economics of chronic heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Berry"
                            1 => "D&#46;R&#46; Murdoch"
                            2 => "J&#46;J&#46; McMurray"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1388-9842(01)00123-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2001"
                        "volumen" => "3"
                        "paginaInicial" => "283"
                        "paginaFinal" => "291"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11377998"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study&#58; a population-based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Davies"
                            1 => "F&#46; Hobbs"
                            2 => "R&#46; Davis"
                            3 => "J&#46; Kenkre"
                            4 => "A&#46;K&#46; Roalfe"
                            5 => "R&#46; Hare"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0140-6736(01)05620-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2001"
                        "volumen" => "358"
                        "paginaInicial" => "439"
                        "paginaFinal" => "444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11513906"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Burden of systolic and diastolic ventricular dysfunction in the community&#58; appreciating the scope of the heart failure epidemic"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;M&#46; Redfield"
                            1 => "S&#46;J&#46; Jacobsen"
                            2 => "J&#46;C&#46; Burnett Jr"
                            3 => "D&#46;W&#46; Mahoney"
                            4 => "K&#46;R&#46; Bailey"
                            5 => "R&#46;J&#46; Rodeheffer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.289.2.194"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2003"
                        "volumen" => "289"
                        "paginaInicial" => "194"
                        "paginaFinal" => "202"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12517230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time trends in characteristics&#44; clinical course&#44; and outcomes of 13&#44;791 patients with acute heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Llorens"
                            1 => "P&#46; Javaloyes"
                            2 => "F&#46;J&#46; Mart&#237;n-S&#225;nchez"
                            3 => "J&#46; Jacob"
                            4 => "P&#46; Herrero-Puente"
                            5 => "V&#46; Gil"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00392-018-1261-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Res Cardiol"
                        "fecha" => "2018"
                        "volumen" => "107"
                        "paginaInicial" => "897"
                        "paginaFinal" => "913"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29728831"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rehospitalizations among patients in the Medicare fee-for-service program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;F&#46; Jencks"
                            1 => "M&#46;V&#46; Williams"
                            2 => "E&#46;A&#46; Coleman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMsa0803563"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "360"
                        "paginaInicial" => "1418"
                        "paginaFinal" => "1428"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19339721"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries&#44; 1998&#8211;2008"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Chen"
                            1 => "S&#46;L&#46; Normand"
                            2 => "Y&#46; Wang"
                            3 => "H&#46;M&#46; Krumholz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2011.1474"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2011"
                        "volumen" => "306"
                        "paginaInicial" => "1669"
                        "paginaFinal" => "1678"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22009099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Public health importance of triggers of myocardial infarction&#58; a comparative risk assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;S&#46; Nawrot"
                            1 => "L&#46; Perez"
                            2 => "N&#46; Kunzli"
                            3 => "E&#46; Munters"
                            4 => "B&#46; Nemery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(10)62296-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2011"
                        "volumen" => "377"
                        "paginaInicial" => "732"
                        "paginaFinal" => "740"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21353301"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Main air pollutants and myocardial infarction&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Mustafic"
                            1 => "P&#46; Jabre"
                            2 => "C&#46; Caussin"
                            3 => "M&#46;H&#46; Murad"
                            4 => "S&#46; Escolano"
                            5 => "M&#46; Tafflet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2012.126"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2012"
                        "volumen" => "307"
                        "paginaInicial" => "713"
                        "paginaFinal" => "721"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22337682"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hospitalizations after heart failure diagnosis a community perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Dunlay"
                            1 => "M&#46;M&#46; Redfield"
                            2 => "S&#46;A&#46; Weston"
                            3 => "T&#46;M&#46; Therneau"
                            4 => "K&#46;H&#46; Long"
                            5 => "N&#46;D&#46; Shah"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2009.08.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol"
                        "fecha" => "2009"
                        "volumen" => "54"
                        "paginaInicial" => "1695"
                        "paginaFinal" => "1702"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19850209"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ischemic and thrombotic effects of dilute diesel-exhaust inhalation in men with coronary heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;L&#46; Mills"
                            1 => "H&#46; Tornqvist"
                            2 => "M&#46;C&#46; Gonzalez"
                            3 => "E&#46; Vink"
                            4 => "S&#46;D&#46; Robinson"
                            5 => "S&#46; S&#246;derberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa066314"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2007"
                        "volumen" => "357"
                        "paginaInicial" => "1075"
                        "paginaFinal" => "1082"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17855668"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diesel exhaust inhalation increases thrombus formation in man"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;J&#46; Lucking"
                            1 => "M&#46; Lundback"
                            2 => "N&#46;L&#46; Mills"
                            3 => "D&#46; Faratian"
                            4 => "S&#46;L&#46; Barath"
                            5 => "J&#46; Pourazar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehn464"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "3043"
                        "paginaFinal" => "3051"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18952612"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adverse cardiovascular effects of air pollution"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;L&#46; Mills"
                            1 => "K&#46; Donaldson"
                            2 => "P&#46;W&#46; Hadoke"
                            3 => "N&#46;A&#46; Boon"
                            4 => "W&#46; MacNee"
                            5 => "F&#46;R&#46; Cassee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ncpcardio1399"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Clin Pract Cardiovasc Med"
                        "fecha" => "2009"
                        "volumen" => "6"
                        "paginaInicial" => "36"
                        "paginaFinal" => "44"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19029991"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Precipitating factors and 90-day outcome of acute heart failure&#58; a report from the intercontinental GREAT registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Arrigo"
                            1 => "E&#46; Gayat"
                            2 => "J&#46; Parenica"
                            3 => "S&#46; Ishihara"
                            4 => "J&#46; Zhang"
                            5 => "D&#46;J&#46; Choi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ejhf.682"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Heart Fail"
                        "fecha" => "2017"
                        "volumen" => "19"
                        "paginaInicial" => "201"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27790819"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "PAPRICA-2 study&#58; role of precipitating factor of an acute heart failure episode on intermediate term prognosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Mir&#243;"
                            1 => "A&#46; Aguirre"
                            2 => "P&#46; Herrero"
                            3 => "J&#46; Jacob"
                            4 => "F&#46;J&#46; Mart&#237;n-S&#225;nchez"
                            5 => "P&#46; Llorens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medcli.2015.01.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2015"
                        "volumen" => "145"
                        "paginaInicial" => "385"
                        "paginaFinal" => "389"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25817454"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seguridad e identificaci&#243;n de factores modificables en los pacientes mayores dados de alta desde urgencias por insuficiencia cardiaca aguda"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Garc&#237;a-&#193;lvarez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "2021"
                        "volumen" => "33"
                        "paginaInicial" => "161"
                        "paginaFinal" => "162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33978327"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictive risk factors for death in elderly patients after hospitalization for acute heart failure in an internal medicine unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Roubille"
                            1 => "B&#46; Eduin"
                            2 => "C&#46; Breuker"
                            3 => "L&#46; Zerkowski"
                            4 => "S&#46; Letertre"
                            5 => "C&#46; Mercuzot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11739-022-02982-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Emerg Med"
                        "fecha" => "2022"
                        "volumen" => "17"
                        "paginaInicial" => "1661"
                        "paginaFinal" => "1668"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35460014"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Resultados a 30 d&#237;as en los pacientes mayores fr&#225;giles con insuficiencia cardiaca aguda dados de alta desde urgencias o sus unidades vinculadas que cumplen los criterios de alto riesgo del estudio DEED FRAIL-AHF"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; Mart&#237;n-S&#225;nchez"
                            1 => "P&#46; Parra Esquivel"
                            2 => "G&#46; Llopis Garc&#237;a"
                            3 => "J&#46; Gonz&#225;lez del Castillo"
                            4 => "E&#46; Rodr&#237;guez Andrada"
                            5 => "B&#46; Espinosa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "2021"
                        "volumen" => "33"
                        "paginaInicial" => "165"
                        "paginaFinal" => "173"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33978329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting 30-day mortality for patients with acute heart failure in the emergency department&#58; a cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "&#210; Mir&#243;"
                            1 => "X&#46; Rossello"
                            2 => "V&#46; Gil"
                            3 => "F&#46;J&#46; Mart&#237;n-S&#225;nchez"
                            4 => "P&#46; Llorens"
                            5 => "P&#46; Herrero-Puente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/M16-2726"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2017"
                        "volumen" => "167"
                        "paginaInicial" => "698"
                        "paginaFinal" => "705"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28973663"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Caracter&#237;sticas cl&#237;nicas&#44; asistenciales y evolutivas de la insuficiencia cardiaca aguda en el clima subtropical&#58; resultados del estudio CANAR-ICA"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Benito Lozano"
                            1 => "O&#46; Mir&#243;"
                            2 => "P&#46; Llorens"
                            3 => "L&#46; Traver&#237;a"
                            4 => "J&#46;M&#46; Pav&#243;n Monz&#243;"
                            5 => "A&#46; Noval de la Torre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "2021"
                        "volumen" => "33"
                        "paginaInicial" => "413"
                        "paginaFinal" => "420"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34813187"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calidad del aire ambiente&#44; inhalaci&#243;n de contaminantes y consultasen los servicios de urgencia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Rodr&#237;guez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "2021"
                        "volumen" => "33"
                        "paginaInicial" => "411"
                        "paginaFinal" => "412"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34813186"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of meteorological temperature and pressure on the severity of heart failure decompensations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "&#210; Mir&#243;"
                            1 => "M&#46; Benito-Lozano"
                            2 => "P&#46; Lopez-Ayala"
                            3 => "S&#46; Rodr&#237;guez"
                            4 => "P&#46; Llorens"
                            5 => "A&#46; Yufera-S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11606-022-07743-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gen Intern Med"
                        "fecha" => "2022"
                        "volumen" => "38"
                        "paginaInicial" => "600"
                        "paginaFinal" => "609"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35941492"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ambient temperature and atmospheric pressure at discharge as precipitating factors in immediate adverse events in patients treated for decompensated heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Benito-Lozano"
                            1 => "P&#46; L&#243;pez-Ayala"
                            2 => "S&#46; Rodr&#237;guez"
                            3 => "V&#46; Gil"
                            4 => "P&#46; Llorens"
                            5 => "A&#46; Yufera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11739-022-03078-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Emerg Med"
                        "fecha" => "2022"
                        "volumen" => "17"
                        "paginaInicial" => "2045"
                        "paginaFinal" => "2056"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36050571"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contaminaci&#243;n atmosf&#233;rica urbana e ingresos hospitalarios por asma y enfermedades respiratorias agudas en la ciudad de Murcia &#40;Espa&#241;a&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;A&#46; Ortega-Garc&#237;a"
                            1 => "I&#46; Mart&#237;nez-Hern&#225;ndez"
                            2 => "E&#46; Boldo"
                            3 => "A&#46; C&#225;rceles-&#193;lvarez"
                            4 => "C&#46; Solano-Navarro"
                            5 => "R&#46; Ramis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr"
                        "fecha" => "2020"
                        "volumen" => "93"
                        "paginaInicial" => "95"
                        "paginaFinal" => "102"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does the meteorological origin of heat waves influence their impact on health&#63; A 6-year morbidity and mortality study in Madrid &#40;Spain&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Ruiz-P&#225;ez"
                            1 => "J&#46; D&#237;az"
                            2 => "J&#46;A&#46; L&#243;pez-Bueno"
                            3 => "M&#46;A&#46; Navas"
                            4 => "I&#46;J&#46; Mir&#243;n"
                            5 => "G&#46;S&#46; Mart&#237;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.scitotenv.2022.158900"
                      "Revista" => array:5 [
                        "tituloSerie" => "Sci Total Environ"
                        "fecha" => "2023"
                        "volumen" => "855"
                        "paginaInicial" => "158900"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36155828"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Gencat&#46; Medio ambiente y sostenibilidad&#46; Descarga de datos autom&#225;ticos &#91;Accessed 30 March 2022&#93;&#46; Available from&#58; <a target="_blank" href="https://mediambient.gencat.cat/es/05_ambits_dactuacio/atmosfera/qualitat_de_laire/vols-saber-que-respires/descarrega-de-dades/descarrega-dades-automatiques/">https&#58;&#47;&#47;mediambient&#46;gencat&#46;cat&#47;es&#47;05&#95;ambits&#95;dactuacio&#47;atmosfera&#47;qualitat&#95;de&#95;laire&#47;vols-saber-que-respires&#47;descarrega-de-dades&#47;descarrega-dades-automatiques&#47;</a>&#46;"
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Portal de datos abiertos del Ayuntamiento de Madrid&#46; Calidad del aire&#46; Datos diarios desde 2001 &#91;Accessed 30 March 2022&#93;&#46; Available from&#58; <a target="_blank" href="https://datos.madrid.es/portal/site/egob/menuitem.c05c1f754a33a9fbe4b2e4b284f1a5a0/?vgnextoid=aecb88a7e2b73410VgnVCM2000000c205a0aRCRD%26vgnextchannel=374512b9ace9f310VgnVCM100000171f5a0aRCRD%26vgnextfmt=default">https&#58;&#47;&#47;datos&#46;madrid&#46;es&#47;portal&#47;site&#47;egob&#47;menuitem&#46;c05c1f754a33a9fbe4b2e4b284f1a5a0&#47;&#63;vgnextoid&#61;aecb88a7e2b73410VgnVCM2000000c205a0aRCRD&#38;vgnextchannel&#61;374512b9ace9f310VgnVCM100000171f5a0aRCRD&#38;vgnextfmt&#61;default</a>&#46;"
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global association of air pollution and heart failure&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;S&#46; Shah"
                            1 => "J&#46;P&#46; Langrish"
                            2 => "H&#46; Nair"
                            3 => "D&#46;A&#46; McAllister"
                            4 => "A&#46;L&#46; Hunter"
                            5 => "K&#46; Donaldson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(13)60898-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2013"
                        "volumen" => "382"
                        "paginaInicial" => "1039"
                        "paginaFinal" => "1048"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23849322"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Regression modeling strategies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46; Harrell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2nd ed&#46;"
                        "fecha" => "2015"
                        "editorial" => "Springer-Verlag"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between exposure to sulphur dioxide air pollution&#44; white cell inflammatory biomarkers and enzymatic infarct size in patients with ST-segment elevation acute coronary syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; D&#237;az-Chir&#243;n"
                            1 => "L&#46; Negral"
                            2 => "L&#46; Megido"
                            3 => "B&#46; Su&#225;rez-Pe&#241;a"
                            4 => "A&#46; Dom&#237;nguez-Rodr&#237;guez"
                            5 => "S&#46; Rodr&#237;guez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.15420/ecr.2021.37"
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Cardiol"
                        "fecha" => "2021"
                        "volumen" => "16"
                        "paginaInicial" => "e50"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34950246"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influencia del di&#243;xido de nitr&#243;geno ambiental en las consultas a urgencias por asma en un entorno con baja contaminaci&#243;n&#58; an&#225;lisis de series temporales y casos cruzados"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Ruiz Albi"
                            1 => "R&#46; L&#243;pez-Izquierdo"
                            2 => "A&#46; Cerezo-Hern&#225;ndez"
                            3 => "F&#46; Moreno"
                            4 => "P&#46; Burgos D&#237;ez"
                            5 => "D&#46; &#193;lvarez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "2021"
                        "volumen" => "33"
                        "paginaInicial" => "421"
                        "paginaFinal" => "426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34813188"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Artificial intelligence MacHIne learning for the detection and treatment of atrial fibrillation guidelines in the emergency department setting &#40;AIM HIGHER&#41;&#58; assessing a machine learning clinical decision support tool to detect and treat non-valvular atrial fibrillation in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Schwab"
                            1 => "D&#46; Nguyen"
                            2 => "G&#46; Ungab"
                            3 => "G&#46; Feld"
                            4 => "A&#46;S&#46; Maisel"
                            5 => "M&#46; Than"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/emp2.12534"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Coll Emerg Physicians Open"
                        "fecha" => "2021"
                        "volumen" => "2"
                        "paginaInicial" => "e12534"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34401870"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Artificial intelligence occult sepsis detection in the emergency department&#58; a large&#44; multicenter real-world data study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "W&#46;F&#46; Peacock"
                            1 => "G&#46;R&#46; Hauser"
                            2 => "P&#46; Toshev"
                            3 => "C&#46; Colovos"
                            4 => "J&#46; Tamay-Sarver"
                            5 => "A&#46; Adib"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Ann Emerg Med"
                        "fecha" => "2021"
                        "volumen" => "78"
                        "paginaInicial" => "S24"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of air pollution on daily hospital admissions for cardiovascular diseases in Castilla-La Mancha"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Rodr&#237;guez"
                            1 => "A&#46;I&#46; Cobo-Cuenca"
                            2 => "R&#46; Quiles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Air Qual Atmosph Health"
                        "fecha" => "2022"
                        "volumen" => "15"
                        "paginaInicial" => "591"
                        "paginaFinal" => "604"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Organizaci&#243;n y pr&#225;ctica cl&#237;nica actual en los servicios de urgencias espa&#241;oles en la atenci&#243;n a los pacientes con insuficiencia cardiaca aguda"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Mir&#243;"
                            1 => "C&#46; S&#225;nchez"
                            2 => "V&#46; Gil"
                            3 => "D&#46; Repullo"
                            4 => "E&#46;J&#46; Garc&#237;a-Lamberechts"
                            5 => "J&#46; Gonz&#225;lez del Castillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "2022"
                        "volumen" => "34"
                        "paginaInicial" => "84"
                        "paginaFinal" => "94"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La organizaci&#243;n asistencial de la insuficiencia cardiaca descompensada en Espa&#241;a&#58; &#191;d&#243;nde estamos&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Lorenzo Hern&#225;ndez"
                            1 => "J&#46; Sanch&#237;s"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "2022"
                        "volumen" => "34"
                        "paginaInicial" => "81"
                        "paginaFinal" => "82"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35275457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23870206/0000016100000001/v2_202311101438/S2387020623002401/v2_202311101438/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "43310"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016100000001/v2_202311101438/S2387020623002401/v2_202311101438/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623002401?idApp=UINPBA00004N"
]

Article information

ISSN: 23870206
Original language: English

DOI:10.1016/j.medcle.2023.02.012

The statistics are updated each day

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter