Influence of Meteorological Temperature and Pressure on the Severity of Heart Failure Decompensations.

OBJECTIVE: To investigate the relationship between ambient temperature and atmospheric pressure (AP) and the severity of heart failure (HF) decompensations. METHODS: We analysed patients coming from the Epidemioloy Acute Heart Failure Emergency (EAHFE) Registry, a multicentre prospective cohort study enrolling patients diagnosed with decompensated HF in 26 emergency departments (EDs) of 16 Spanish cities. We recorded patient and demographic data and maximum temperature (Tmax) and AP (APmax) the day before ED consultation. Associations between temperature and AP and severity endpoints were explored by logistic regression. We used restricted cubic splines to model continuous non-linear associations of temperature and AP with each endpoint. RESULTS: We analysed 16,545 patients. Daily Tmax and APmax (anomaly) of the day before patient ED arrival ranged from 0.8 to 41.6° and from - 61.7 to 69.9 hPa, respectively. A total of 12,352 patients (75.2%) were hospitalised, with in-hospital mortality in 1171 (7.1%). The probability of hospitalisation by HF decompensation showed a U-shaped curve versus Tmax and an increasing trend versus APmax. Regarding temperature, hospitalisation significantly increased from 20 °C (reference) upwards (25 °C: OR = 1.12, 95% CI = 1.04-1.21; 40 °C: 1.65, 1.13-2.40) and below 5.4 °C (5 °C: 1.21, 1.01-1.46). Concerning the mean AP of the city (anomaly = 0 hPa), hospitalisation increased when APmax (anomaly) was above + 7.0 hPa (atmospheric anticyclone; + 10 hPa: 1.14, 1.05-1.24; + 30 hPa: 2.02. 1.35-3.03). The lowest probability of mortality also corresponded to cold-mild temperatures and low AP, with a significant increased risk only found for Tmax above 24.3 °C (25 °C: 1.13, 1.01-1.27; 40 °C: 2.05, 1.15-3.64) and APmax (anomaly) above + 3.4 hPa (+ 10 hPa: 1.21, 1.07-1.36; + 30 hPa: 1.73, 1.06-2.81). Sensitivity analysis confirmed the main analysis results. CONCLUSION: Temperature and AP are independently associated with the severity of HF decompensations, with possible different effects on the need for hospitalisation and in-hospital mortality.

Características clínicas, asistenciales y evolutivas de la insuficiencia cardiaca aguda en el clima subtropical: resultados del estudio CANAR-ICA / Acute heart failure in subtropical climates: clinical characteristics, management, and outcomes in the Canary Islands versus continental Spain — the CANAR-ICA study results

Objetivo: Investigar si existen diferencias clínicas, asistenciales y evolutivas entre los episodios de insuficiencia cardiaca aguda (ICA) desarrollados en residentes en las Islas Canarias (CAN), de clima subtropical, y en los del territorio español continental (CON). Método: Los pacientes con ICA incluidos en el registro EAHFE se dividieron en CAN o CON. Se recogieron 38 variables demográficas, de estado clínico basal, clínicas y terapéuticas. Se analizó la mortalidad intrahospitalaria y a los 30 días, la hospitalización prolongada (> 7 días) y el evento combinado post-alta (reconsulta o muerte a 30 días). Se compararon los pacientes CAN y CON, ajustando los resultados por las diferencias entre grupos. Resultados: Se incluyeron 18.390 pacientes: CAN = 697 (3,8%), CON = 17.673 (96,2%). Tras el ajuste, los CAN eran más jóvenes, más frecuentemente mujeres, tenían más antecedentes de hipertensión, diabetes e ICA previa, y estaban en clase funcional más avanzada, pero tenían menos dislipemia, valvulopatías y dependencia funcional, y recibían menos frecuentemente inhibidores del eje renina-angiotensina. Aunque la gravedad del episodio de descompensación fue similar, los CAN recibían más tratamientos endovenosos en urgencias y se hospitalizaban menos. El riesgo ajustado de hospitalización prolongada en los CAN resultó incrementado (OR 2,36; IC 95%:1,52-3,02), pero no hubo diferencias en la mortalidad intrahospitalaria (OR 0,97; IC 95%: 0,68-1,37), a 30 días (OR 0,9; IC 95%: 0,67-1,27) o en los eventos combinados post-alta a los 30 días (OR 1,19; IC 95%: 0,93-1,53). (AU)

Objectives: To determine whether there are differences in the clinical characteristics, management, and outcome of episodes of acute heart failure (AHF) in residents of the Canary Islands, where the climate is subtropical, and episodes in continental Spain. Material and methods: Cases were identified in the registry for Epidemiology of Acute Heart Failure in Emergency Departments and categorized as in the Canary Islands or continental Spain. Data for 38 demographic, baseline, clinical, and therapeutic variables were extracted. We analyzed statistics for in-hospital and 30-day mortality, long hospital stay (more than 7 days), and a composite outcome after discharge (revisits or death within 30 days). The results for island and continental patients were compared and adjusted for between-group differences. Results: A total of 18 390 patients were studied, 697 islanders (3.8%) and 17 673 continental patients (96.2%). Comparisons showed that the islanders were younger; more often women; and more likely to have hypertension, diabetes, and a prior AHF episode. Their New York Heart Association functional class was also likely to be higher. However, their rates of dyslipidemia, valve disease, and functional dependence were lower, and they were also less likely to be on reninangiotensin system blockers. Although the severity of cardiac decompensation was similar in island and continental patients, the islanders received more intravenous treatments in the emergency department and were admitted less often. The adjusted risk of a long hospital stay was higher for the islanders (odds ratio [OR], 2.36; 95% CI, 1.52-3.02) but their risk for mortality and the composite outcome did not differ: in-hospital mortality, OR 0.97 (95% CI, 0.68-1.37); 30-day mortality, OR, 0.9 (95% CI, 0.67-1.27); and the post-discharge composite, OR, 1.19 (95% CI, 0.93-1.53). (AU)

Acute heart failure in subtropical climates: clinical characteristics, management, and outcomes in the Canary Islands versus continental Spain - the CANAR-ICA study results. / Características clínicas, asistenciales y evolutivas de la insuficiencia cardiaca aguda en el clima subtropical: resultados del estudio CANAR-ICA.

OBJECTIVES: To determine whether there are differences in the clinical characteristics, management, and outcome of episodes of acute heart failure (AHF) in residents of the Canary Islands, where the climate is subtropical, and episodes in continental Spain. MATERIAL AND METHODS: Cases were identified in the registry for Epidemiology of Acute Heart Failure in Emergency Departments and categorized as in the Canary Islands or continental Spain. Data for 38 demographic, baseline, clinical, and therapeutic variables were extracted. We analyzed statistics for in-hospital and 30-day mortality, long hospital stay (more than 7 days), and a composite outcome after discharge (revisits or death within 30 days). The results for island and continental patients were compared and adjusted for between-group differences. RESULTS: A total of 18 390 patients were studied, 697 islanders (3.8%) and 17 673 continental patients (96.2%). Comparisons showed that the islanders were younger; more often women; and more likely to have hypertension, diabetes, and a prior AHF episode. Their New York Heart Association functional class was also likely to be higher. However, their rates of dyslipidemia, valve disease, and functional dependence were lower, and they were also less likely to be on reninangiotensin system blockers. Although the severity of cardiac decompensation was similar in island and continental patients, the islanders received more intravenous treatments in the emergency department and were admitted less often. The adjusted risk of a long hospital stay was higher for the islanders (odds ratio [OR], 2.36; 95% CI, 1.52-3.02) but their risk for mortality and the composite outcome did not differ: in-hospital mortality, OR 0.97 (95% CI, 0.68-1.37); 30-day mortality, OR, 0.9 (95% CI, 0.67-1.27); and the post-discharge composite, OR, 1.19 (95% CI, 0.93-1.53). CONCLUSION: Baseline patient characteristics and clinical management of AHF episodes differ between the subtropical region and those in southern continental Europe. Hospitalization was required less often, but hospital stays were longer.

OBJETIVO: Investigar si existen diferencias clínicas, asistenciales y evolutivas entre los episodios de insuficiencia cardiaca aguda (ICA) desarrollados en residentes en las Islas Canarias (CAN), de clima subtropical, y en los del territorio español continental (CON). METODO: . Los pacientes con ICA incluidos en el registro EAHFE se dividieron en CAN o CON. Se recogieron 38 variables demográficas, de estado clínico basal, clínicas y terapéuticas. Se analizó la mortalidad intrahospitalaria y a los 30 días, la hospitalización prolongada (> 7 días) y el evento combinado post-alta (reconsulta o muerte a 30 días). Se compararon los pacientes CAN y CON, ajustando los resultados por las diferencias entre grupos. RESULTADOS: Se incluyeron 18.390 pacientes: CAN = 697 (3,8%), CON = 17.673 (96,2%). Tras el ajuste, los CAN eran más jóvenes, más frecuentemente mujeres, tenían más antecedentes de hipertensión, diabetes e ICA previa, y estaban en clase funcional más avanzada, pero tenían menos dislipemia, valvulopatías y dependencia funcional, y recibían menos frecuentemente inhibidores del eje renina-angiotensina. Aunque la gravedad del episodio de descompensación fue similar, los CAN recibían más tratamientos endovenosos en urgencias y se hospitalizaban menos. El riesgo ajustado de hospitalización prolongada en los CAN resultó incrementado (OR 2,36; IC 95%:1,52-3,02), pero no hubo diferencias en la mortalidad intrahospitalaria (OR 0,97; IC 95%: 0,68-1,37), a 30 días (OR 0,9; IC 95%: 0,67-1,27) o en los eventos combinados post-alta a los 30 días (OR 1,19; IC 95%: 0,93-1,53). CONCLUSIONES: Existen diferencias tanto en las características basales como en el manejo clínico de los episodios de insuficiencia cardiaca en los residentes de una región subtropical respecto a los de una zona meridional europea. Además, tienen menor necesidad de hospitalización, aunque estas son más prolongadas.

Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study.

OBJECTIVE: To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. METHODS: Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (<6/6-10/11-15/>15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6 days vs. LOH <6 days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units. RESULTS: We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4-11): 2934 (34.3%) had a LOH <6 days, 3184 (37.2%) 6-10 days, 1287 (15.0%) 11-15 days, and 1158 (13.5%) >15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CI = 13.0-64.9) when LOH was 11-15 days, and by 72.0% (95%CI = 42.6-107.5) when >15 days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CI = 8.4-36.4) for LOH >15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15 days and no significant increments in readmission risk. CONCLUSIONS: Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments.