Precipitating factors of heart failure admission: Differences related to age and left ventricular ejection fraction

Abstract

Aim To evaluate precipitating factors (PF) of exacerbation in heart failure (HF) and their relationship with age, preserved vs. reduced left ventricular ejection fraction (LVEF) and short-term prognosis.

Methods We included and followed 2962 patients admitted with acute HF to Internal Medicine Units. Several PF were identified. Differences in PF according to preserved vs. reduced LVEF and age (patients ≥ 80 years vs. younger) were analyzed. Primary endpoints were readmission due to worsening HF and all-cause mortality at 3 months follow-up. Multivariable Cox models were conducted to identify the independent predictors of 3-months mortality and readmission.

Results More than half of the patients were 80 years and over, 47% were women and 61% had preserved LVEF. Atrial fibrillation (AF) and myocardial ischemia were the more common cause of decompensation among octogenarians. It was more frequent to find myocardial ischemia or non-adherence to treatment as precipitants in patients with systolic dysfunction. However, respiratory infections, AF and poor control of blood pressure were more usual in patients with preserved LVEF compared to those with LVEF < 50%.

Patients admitted for HF precipitated by myocardial ischemia had a higher risk of readmission at 3 months (HR 1.49; CI 95%: 1.12–1.99, p = 0.006) and the longest hospital stay (12 days). PF showed no predictive value for mortality.

Conclusion Myocardial ischemia as a PF was an independent marker for HF readmissions at 3-months follow-up. Precipitants are different depending on the age and LVEF of patients. Their identification could improve risk stratification and prevention strategies.