Trends and predictors of non-cardiovascular death in patients hospitalized for acute heart failure

Background: Little information is available on non-cardiovascular (CV) death in acute heart failure (AHF) patients. The present study determined the incidence, time course, and factors associated with long-termnon-CV death in AHF patients in a real-world setting. Methods: The ATTEND registry, a nationwide, prospective observational multicenter cohort study, included 4842 consecutive patients hospitalized for AHF. The primary endpoint of the present study was non-CV death. Results: Median follow-up duration from admission was 513 (range, 385-778) days. Over the study period, 1183 patients died; 356 deaths (30.1%) were non-CV related. The proportion of non-CV deaths increased in the later follow-up phase (0-180 days, 26.7%; 181-360 days, 38.4%; >360 days, 36.6%, p < 0.001). After adjustment for all variables at baseline, age (hazard ratio [HR] 1.6 per decade, p < 0.001) and non-cardiac comorbidities including chronic obstructive pulmonary disease (HR 1.58, p=0.003), history of stroke (HR 1.44, p=0.011), renal insufficiency (HR 1.07, per 10ml/min/1.73m(2) decrease in estimated glomerular filtration, p=0.015), and hemoglobin (HR 1.15 per 1.0g/dl decrease, p < 0.001) were strongly associated with non-CV death. Other predictors included ischemic etiology (HR 1.33, p = 0.023), prior hospitalization for heart failure (HR 1.34, p = 0.017), C-reactive protein (HR 1.04, p < 0.001), and statin use (HR 0.70, p = 0.016). Conclusions: The incidence of non-CV death was high in patients with AHF, accounting for 30% of long-term mortality. Furthermore, the proportion of non-CV death increased in the later follow-up phase. Better understanding of non-CV death and more comprehensive treatment of non-CV comorbidities are vital to further improving prognosis in AHF patients. (C) 2017 Elsevier B.V. All rights reserved.