Clinical presentation and outcomes of acute heart failure in the critically ill patient: A prospective, observational, multicentre study

Aims: To assess the clinical profile and factors associated with 30-day mortality in patients with acute heart failure (AHF) admitted to the intensive care unit (ICU).Design: Prospective, multicentre cohort study.Scope: Thirty-two Spanish ICUs.Patients: Adult patients admitted to the ICU between April and June 2017.Intervention: Patients were classified into three groups according to AHF status: without AHF (no AHF); AHF as the primary reason for ICU admission (primary AHF); and AHF developed during the ICU stay (secondary AHF).Main variables of interest: Incidence of AHF and 30-day mortality.Results: A total of 4330 patients were included. Of these, 627 patients (14.5%) had primary (n = 319; 7.4%) or secondary (n = 308; 7.1%) AHF. Among the main precipitating factors, fluid overload was more common in the secondary AHF group than in the primary group (12.9% vs Zapata, Guia, 23.4%, p < 0.001). Patients with AHF had a higher risk of 30-day mortality than those without AHF (OR 2.45; 95% CI: 1.93-3.11). APACHE II, cardiogenic shock, left ventricular ejec-tion fraction, early inotropic therapy, and diagnostic delay were independently associated with 30-day mortality in AHF patients. Diagnostic delay was associated with a significant increase in 30-day mortality in the secondary group (OR 6.82; 95% CI 3.31-14.04).Conclusions: The incidence of primary and secondary AHF was similar in this cohort of ICU patients. The risk of developing AHF in ICU patients can be reduced by avoiding modifiable pre-cipitating factors, particularly fluid overload. Diagnostic delay was associated with significantly higher mortality rates in patients with secondary AHF.(c) 2022 Elsevier Espana, S.L.U. y SEMICYUC. All rights reserved.