Prognostic impact of cardiac versus non cardiac triggers in acute heart failure patients : the OFICA2 French Cohort.
M Tortigue, N Mewton, D Legallois, E Puymirat, J Costa, A Menet, M Doublet, D Logeart, C BouletiAbstract
Background
Acute heart failure (AHF) represents a major cause of morbi-mortality and can be precipitated by cardiac or extra-cardiac triggers.
Purpose
The aim of our study was to describe contemporary data on AHF triggers and to compare the prognostic value of cardiac versus extra-cardiac triggers on one-year all-cause mortality.
Methods
OFICA2 is a French prospective multicenter cohort led from March to April 2021 across 80 participating centers. Triggers of AHF decompensations were considered as cardiac if there were primary (no obvious alternative cause), acute coronary syndrome (ACS), or cardiac arrhythmias. Extra-cardiac triggers included blood pressure disorders, anemia, infection, and non-compliance to guideline-directed medical treatment (GDMT). The primary outcome was all-cause mortality at one year, assessed through linkage with national administrative databases.
Results
Among 1432 patients (mean age 76 years, 61% male) hospitalized for AHF, 1,224 (81.0%) were successfully linked to the national death registry and had an identified trigger. Cardiac triggers (70.3%) were more frequent than extra-cardiac triggers (29.7%). A primary cardiac cause (47.7%) was the most frequent cardiac trigger, while infections (46.9%) were the most frequent extra-cardiac trigger. Patients with cardiac triggers had significantly lower LVEF compared with those with extra-cardiac triggers (39.0 ±14.8 % versus 45.7±15.4% respectively; p<0.001). One-year all-cause mortality did not significantly differ between patients with cardiac and extra-cardiac triggers (27.3% versus 28.3%, respectively, p=0.79) (Figure 1). In exploratory analyses, AHF related to GDMT non-compliance seemed to be associated with the worst prognosis, while events caused by hypertension disorders were associated with a better prognosis (Figure 2).
Conclusions
In this contemporary nationwide cohort, cardiac triggers were approximately twice as frequent as extra-cardiac triggers among patients hospitalized for AHF. However, there was no difference in one-year all-cause mortality rates between those triggers. AHF events related to non-compliance with GDMT appeared to be associated with the worst prognosis, a finding that warrants further investigation.Figure 1For image description, please refer to the figure legend and surrounding text.Figure 2For image description, please refer to the figure legend and surrounding text.