New onset heart failure--Clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study.

BACKGROUND: Heart failure (HF) is a growing global epidemic. The main study aims is to evaluate the differences between new-onset and chronic-decompensated HF patients. Secondary objectives related only to new-onset HF patients include the role of left ventricular ejection fraction (LVEF) and mid-term mortality related risk factors METHODS: We analyzed 2190 patients hospitalized for acute HF. We compare the 683 patients with a new-onset HF episode with the rest. Restricting the analysis to the new-onset HF patients, we also compare patients with preserved LVEF (EF>50%) with those with reduced LVEF, and analyze the factors associated with three-month mortality. RESULTS: A total of 683 (31.2%) patients fulfill the criteria for "new-onset HF". These patients are older, their HF is more often related to hypertension, show higher blood pressure and heart rate values upon admission, and present with less global and disease-specific comorbidity and better baseline overall functional status. New-onset HF is more often characterized by preserved LVEF, milder baseline NYHA class and lower plasma natriuretic peptide values. After 3 months; 33 (5.2%) new-onset HF patients had died (p<0.001). Cox multivariate analysis showed a correlation between mortality and older age (hazard ratio - HR - 1.08), higher global comorbidity (HR 1.20) and lesser prescription of beta-blockers at discharge (HR 0.34). LVEF was unrelated to mortality. CONCLUSIONS: New-onset HF patients show a clinical profile different to that of chronic-decompensated patients. For this subset of acute HF patients older age, higher comorbidity and beta-blocker nonprescription predict a higher risk of mid-term post-discharge mortality.

Association between type-2 diabetes mellitus and post-discharge outcomes in heart failure patients: findings from the RICA registry.

AIMS: Heart failure (HF) and diabetes are common clinical conditions that may coexist. The main objective was to analyze the association of type-2 diabetes mellitus (T2DM) on prognosis in hospitalized patients with HF. METHODS: We evaluated the association between T2DM with all-cause mortality and readmissions in the Spanish National Registry on Heart Failure-"Registro Nacional de Insuficiencia Cardiaca" (RICA). This is a multi-center and prospective cohort study that includes patients admitted for decompensated HF from 2008 to 2011. Study endpoints were all-cause mortality and hospital readmission. We determined the adjusted hazard ratio (HR) by a multivariable Cox regression model. RESULTS: A total of 1082 patients (mean age 77.6±8.5) were included of whom 490 (45.3%) had diabetes and 592 patients (54.7%) had preserved left ventricular ejection fraction (LVEF). During one-year follow-up, 287 patients died (151 patients with diabetes) and 383 patients were readmitted (197 patients with diabetes). After adjusting for baseline characteristics T2DM was significantly associated with all-cause mortality (HR 1.54; 95%CI 1.20-1.97, p=0.001) and readmissions (HR 1.46; 95%CI 1.18-1.80, p<0.001). Age, dementia, peripheral vascular disease, NYHA class, renal insufficiency, hyponatremia and anemia were also independently associated with outcomes. There were no differences in mortality (p=0.415) and readmissions (p=0.514) according to preserved or reduced LVEF. CONCLUSION: T2DM is very common in patients hospitalized for HF. This condition is a strong and independent co-morbidity of all-cause mortality and readmission for both HF with preserved and reduced LVEF.

Basal functional status predicts three-month mortality after a heart failure hospitalization in elderly patients - the prospective RICA study.

BACKGROUND: Many elderly heart failure (HF) patients show some degree of functional impairment. The study aim was to evaluate the functional status of oldest-old cohort of patients hospitalized with a diagnosis of decompensated (HF), and to analyze whether preadmission functional status predicts risk of 3-month mortality. METHODS: We analyzed 1431 elderly (≥ 75 years) patients prospectively included in the Spanish National Registry on HF (RICA). We added Barthel Index (BI) to the usual HF patient assessment to measure patients' functional status, and we evaluated the relationship between preadmission BI values and 3-month mortality. RESULTS: The mean age of patients was 82.3 (4.6) years. Patients' mean preadmission BI score was 81.3 (21.5); 802 patients (55.9%) had BI scores <61. Multivariate analysis confirmed an independent association between poor preadmission BI and older age, female sex, higher comorbidity, cognitive impairment, previous institutionalization, worse New York Heart Association (NYHA) functional class and lack of beta-blocker use. A total of 210 patients died (14.7%) after 3 months of follow-up. Cox multivariate analyses found that higher preadmission BI is correlated with reduced all-cause, 3-month postdischarge mortality [hazard ratio (HR) 0.981; CI95% 0.975-0.986, p<0.001]. Other variables independently associated with 3-month mortality were male sex, lower body mass index, lower systolic blood pressure, a diagnosis of diabetes and chronic kidney disease, worse NYHA class and not receiving treatment with beta-blockers. CONCLUSIONS: Severe functional disability is present among more than half of older patients admitted because of a HF decompensation. For this population, preadmission BI is a strong predictor of short-term mortality.