• Jose Maria Verdú-Rotellar, Esther Calero, Rosa Abellana, José Verdú-Soriano, Ernest Vinyoles, José Luis Del Val-García, Mar Domingo, and Miguel-Angel Muñoz.
• Gerencia Atención Primaria de Barcelona, Institut Català de la Salut, Barcelona, Spain; Primary Health Care University Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain; School of Medicine, Universitat Autonoma de Barcelona, Bellaterra, Spain.
• Aten Primaria. 2020 Aug 1; 52 (7): 477-487.

ObjectivesThis study is aimed at analyzing the impact of the main factors contributing to short and long-term mortality in patients at final stages of heart failure (HF).SettingPatients attended at any of the 279 primary health care centers belonging to the Institut Català de la Salut, in Catalonia (Spain).ParticipantsPatients with Advanced HF.DesignMulticenter cohort study including 1148 HF patients followed for one-year after reaching New York Heart Association (NYHA) IV.Main MeasurementsThe primary outcome was all-cause mortality. Multivariate logistic regression models were performed to assess the outcomes at 1, 3, 6, and 12 months.ResultsMean age of patients was 82 (SD 9) years and women represented 61.7%. A total of 135 (11.8%) and 397 (34.6%) patients died three months and one year after inclusion, respectively. Male gender, age, and decreased body mass index were associated with higher mortality at three, six and twelve months. In addition, low systolic blood pressure levels, severe reduction in glomerular filtration, malignancy, and higher doses of loop diuretics were related to higher mortality from 6 to 12 months. The most important risk factor over the whole period was presenting a body mass index lower than 20kg/m2 (three months OR 3.06, 95% CI: 1.58-5.92; six months OR 4.42, 95% CI: 2.08-9.38; and 12 months OR 3.68, 95% CI: 1.76-7.69).ConclusionsWe may conclude that male, age, and decreased body mass index determined higher short-term mortality in NYHA IV. In addition, low systolic blood pressure, reduced glomerular filtration, malignancy, and higher doses of loop diuretics contribute to increasing the risk of mortality at medium and long-term. Such variables are easily measurable and can help to decide the best way to face the most advances stages of the disease.Copyright © 2019 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

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