Effect of precipitating factors of acute heart failure on readmission and long-term mortality

Aims: Acute heart failure (AHF) is one of the leading causes of unscheduled hospitalization and is associated with frequent readmissions and substantial mortality. Precipitating factors of AHF influence short-term mortality, but their effect on outcome after hospital discharge is unknown. The present study assessed the effect of precipitating factors on readmission and long-term survival in the overall population and in patients aged 75 years or younger. Methods and results: Patients admitted with AHF (n = 755) included in the multicentre cohort ‘Biomarcoeurs’ were included in the study. Precipitating factors of AHF were classified in four main groups: acute coronary syndrome, atrial fibrillation, acute pulmonary disease and other causes. Hospital readmission during 90 days after discharge and survival at 1 year were analysed. Precipitating factors influenced readmissions and survival. Acute pulmonary disease was associated with fewer readmissions (HR 0.61, 95% confidence interval (CI) 0.37–0.99, P = 0.049), especially in patients aged 75 years or younger (HR 0.20, 95% CI 0.06–0.63, P = 0.006), whereas atrial fibrillation (HR 2.23, 95% CI 1.29–3.85, P = 0.004) and acute coronary syndrome (HR 2.23, 95% CI 1.02–4.86, P = 0.044) were associated with more readmissions. Patients with acute pulmonary disease at admission showed higher mortality (HR 1.59, 95% CI 1.04–2.43, P = 0.034), especially in subjects aged 75 years or younger (HR 2.52, 95% CI 1.17–5.41, P = 0.018). Conclusions: Precipitating factors of AHF substantially influenced outcome after hospitalization. In particular, patients with AHF precipitated by acute pulmonary disease showed fewer readmissions and higher 1 year mortality, especially in patients aged 75 years or younger.