Author + information
- Received July 29, 2017
- Revision received September 17, 2017
- Accepted September 19, 2017
- Published online December 25, 2017.
- Òscar Miró, MD, PhDa,b,∗ (, )
- Ramon Estruch, MD, PhDb,c,d,
- Francisco J. Martín-Sánchez, MD, PhDe,
- Víctor Gil, MD, PhDa,
- Javier Jacob, MD, PhDf,
- Pablo Herrero-Puente, MD, PhDg,
- Sergio Herrera Mateo, MDh,
- Alfons Aguirre, MDi,
- Juan A. Andueza, MDj,
- Pere Llorens, MD, PhDk,
- on behalf of the ICA-SEMES Research Group∗
- aEmergency Department, Hospital Clínic, IDIBAPS, Barcelona, Spain
- bSchool of Medicine, University of Barcelona, Barcelona, Spain
- cDepartment of Internal Medicine, Hospital Clínic, IDIBAPS, Barcelona, Spain
- dCIBER OBN, Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain
- eEmergency Department, Hospital Clínico San Carlos, Madrid, Universidad Complutense de Madrid, Madrid, Spain
- fEmergency Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- gEmergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- hEmergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- iEmergency Department, Hospital del Mar, Barcelona, Spain
- jEmergency Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- kEmergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, ISABIAL-FISABIO, Alicante, Spain
- ↵∗Address for correspondence:
Dr. Òscar Miró, Emergency Department, Hospital Clínic, Villarroel 170, 08036 Barcelona, Catalonia, Spain.
Objectives The authors sought to evaluate clinical outcomes of patients after an episode of acute heart failure (AHF) according to their adherence to the Mediterranean diet (MedDiet).
Background It has been proved that MedDiet is a useful tool in primary prevention of cardiovascular diseases. However, it is unknown whether adherence to MedDiet is associated with better outcomes in patients who have already experienced an episode of AHF.
Methods We designed a prospective study that included consecutive patients diagnosed with AHF in 7 Spanish emergency departments (EDs). Patients were included if they or their relatives were able to answer a 14-point score of adherence to the MedDiet, which classified patients as adherents (≥9 points) or nonadherents (≤8 points). The primary endpoint was all-cause mortality at the end of follow-up, and secondary endpoints were 1-year ED revisit without hospitalization, rehospitalization, death, and a combined endpoint of all these variables for patients discharged after the index episode. Unadjusted and adjusted hazard ratios (HRs) were calculated.
Results We included 991 patients (mean age of 80 ± 10 years, 57.8% women); 523 (52.9%) of whom were adherent to the MedDiet. After a mean follow-up period of 2.1 ± 1.3 years, no differences were observed in survival between adherent and nonadherent patients (HR of adherents [HRadh] = 0.86; 95% confidence interval [CI]: 0.73 to 1.02). The 1-year cumulative ED revisit for the whole cohort was 24.5% (HRadh = 1.10; 95% CI: 0.84 to 1.42), hospitalization 43.7% (HRadh = 0.74; 95% CI: 0.61 to 0.90), death 22.7% (HRadh = 1.05; 95% CI: 0.8 to 1.38), and combined endpoint 66.8% (HRadh = 0.89; 95% CI: 0.76 to 1.04). Adjustment by age, hypertension, peripheral arterial disease, previous episodes of AHF, treatment with statins, air-room pulsioxymetry, and need for ventilation support in the ED rendered similar results, with no statistically significant differences in mortality (HRadh = 0.94; 95% CI: 0.80 to 1.13) and persistence of lower 1-year hospitalization for adherents (HRadh = 0.76; 95% CI: 0.62 to 0.93).
Conclusions Adherence to the MedDiet did not influence long-term mortality after an episode of AHF, but it was associated with decreased rates of rehospitalization during the next year.
↵∗ For a list of the other investigators of the ICA-SEMES Research Group, please see the online version of this paper.
This work was partially supported by grants from the Instituto de Salud Carlos III, the Spanish Ministry of Health and FEDER (PI10/01918, PI11/01021, PI15/01019, PI15/00773), Fundació La Marató de TV3 (2015/2510), and Catalonia Govern for Consolidated Groups of Investigation (GRC 2009/1385, 2014/0313). The ICA-SEMES Research Group has received unrestricted support from Orion Pharma and Novartis. The present study was designed, performed, analyzed, and written exclusively by the authors independently from these pharmaceutical companies. The authors have reported that they have no relationships relevant to the contents of this paper to report.
- Received July 29, 2017.
- Revision received September 17, 2017.
- Accepted September 19, 2017.
- 2018 American College of Cardiology Foundation