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registry&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> a multicenter&#44; multipurpose&#44; analytical&#44; noninterventional registry&#44; with a prospective follow-up that consecutively includes all patients treated for AHF in 34 Spanish HEDs&#46; The inclusion criteria were compliance with the AHF diagnostic criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> Whenever possible&#44; the diagnosis was confirmed by measuring natriuretic peptide levels or performing an echocardiogram&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> Patients with AHF in the context of an acute coronary syndrome with ST-segment elevation &#40;STE-ACS&#41; were excluded&#46; The EAHFE Registry complies with the Declaration of Helsinki&#44; and all patients signed an informed consent document&#46; The protocol was approved by the Clinical Research Ethics Committees of the participating hospitals&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study included patients from EAHFE-1 &#40;2007&#41; to EAHFE-4 &#40;2014&#41;&#46; The data collection method was similar for the 4 periods and has been previously published&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10&#44;12</span></a> The study included all patients who had the study variable&#58; a first episode of AHF or decompensated HF in patients with a previous episode of AHF&#44; differentiating between NOAHF and CDHF&#46; Patients were considered to have NOAHF if they had an initial decompensated AHF that required emergency care&#46; This information was obtained from an anamnesis directed at the patient or relatives&#44; and there were no previous episodes with a diagnosis of heart failure in the medical history review&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We collected demographic variables&#44; personal history&#44; baseline functional state&#44; previous long-term therapy&#44; episode triggers&#44; vital signs during the acute episode&#44; complementary tests&#44; treatment administered in the emergency department and the episode outcome&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The primary endpoint was all-cause mortality during the year following the emergency department admission for the index event&#46; The secondary endpoints were hospital mortality during the index event&#44; 30-day mortality&#44; 12-month mortality and HED readmission for AHF at 30 days of the discharge&#46; This information was verified by telephone calls and by consulting the electronic medical record at 30 days&#44; 90 days and after a year&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the statistical analysis&#44; the quantitative variables are expressed as mean and standard deviation &#40;SD&#41;&#44; and the qualitative variables are expressed as absolutes and percentages&#46; The univariate analysis of the quantitative variables employed Student&#39;s <span class="elsevierStyleItalic">t</span>-test and the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test for the variables that did not follow a normal distribution according to the Kolmogorov&#8211;Smirnov test&#46; The qualitative variables were analyzed with the chi-squared test and Fisher&#39;s exact text&#44; as necessary&#46; To assess the prognostic value of NOAHF in terms of 30-day readmission&#44; hospital mortality and 30-day mortality&#44; we compared the effects of the NOAHF variable to those of CDHF&#44; expressed as the crude odds ratio &#40;OR&#41; with its 95&#37; confidence interval &#40;95&#37; CI&#41;&#46; The results were subsequently adjusted using a logistic regression analysis that included all variables with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05 in the univariate analysis&#46; We performed 3 separate fit models using the insertion method&#58; the first by the differences in the baseline characteristics&#44; the second by the differences in the acute episode and the third by the 2 previous models simultaneously&#46; To assess the prognostic value of NOAHF in terms of 12-month survival&#44; we created survival curves according to the Kaplan&#8211;Meier method&#44; comparing them with the log-rank test&#46; We also calculated the crude hazard ratio &#40;HR&#41; and its 95&#37; CI using the Cox regression method and then adjusted it based on the same strategy described for OR&#46; For all comparisons&#44; we accepted that the differences were statistically significant when the <span class="elsevierStyleItalic">p</span>-value was &#60;&#46;05 or when the 95&#37; CI of the HR or the OR excluded the value 1&#46; The statistical analysis was conducted with the SPSS 24&#46;0 program for Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Of the 9078 patients included in the EAHFE 1&#8211;4&#44; the NOVICA study included 8647 patients&#46; The study excluded 431 &#40;4&#46;74&#37;&#41; for lacking information on the chronology of the episode &#40;first episode or decompensation&#41;&#44; and the rest were classified as NOAHF &#40;3288&#44; 38&#37;&#41; or CDHF &#40;5359&#44; 62&#37;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the patients&#8217; baseline characteristics&#46; The patients with CDHF were older and had a higher prevalence of practically all analyzed comorbidities&#44; as well as a poorer baseline status&#46; Likewise&#44; the patients with CDHF underwent treatment more frequently with most of the drugs studied&#44; except for thiazide diuretics and ARB-II&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the data regarding the AHF episode&#46; Overall&#44; infection was the most common trigger&#46; We can observe that atrial fibrillation and coronary ischemia were more common in the patients with NOAHF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; and that infection and therapeutic noncompliance were more common in the patients with CDHF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; There was a notably higher use of invasive ventilation and continuous intravenous infusions in the patient group with CDHF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; Of the total&#44; 6457 patients were hospitalized &#40;74&#46;7&#37;&#41;&#46; The most common destination for both groups was internal medicine&#44; with no statistically significant differences between them &#40;NOAHF 30&#46;7&#37;&#44; CDHF 33&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;19&#41;&#46; The patients with NOAHF were admitted more often to cardiology departments and intensive care units &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; and the patients with CDHF were more often admitted to short-stay units &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In terms of prognosis&#44; mortality and readmission at 30 days for AHF&#44; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the unadjusted results&#46; At 1 year of the emergency department admission for AHF&#44; 507 patients with NOAHF died &#40;11&#46;7&#37;&#41;&#44; compared with 1150 patients &#40;32&#46;9&#37;&#41; with CDHF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the crude survival curves&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the prognosis&#44; crude and adjusted survival &#40;hospital&#44; 30-day and 1-year&#41; and HED readmission for AHF at 30 days&#46; We performed adjusted models for the differences in the baseline characteristics &#40;model A&#41;&#44; for the differences in the episode characteristics &#40;model B&#41; and for all differences between the 2 groups &#40;model C&#41;&#46; In the models adjusted for all variables &#40;model C&#41;&#44; there were no differences in mortality&#44; but there were differences for 30-day readmission for AHF&#44; which was lower for the patients with NOAHF &#40;OR&#44; 0&#46;756&#59; 95&#37; CI 0&#46;667&#8211;0&#46;869&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">NOVICA is the first study in Spain to investigate the characteristics and outcomes of patients who are admitted to HEDs for AHF based on whether this involved a first episode or a decompensation&#46; Similar previous publications have employed smaller samples and were conducted with hospitalized patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5&#8211;7&#44;13&#8211;15</span></a> We believe these results are representative of the current reality of AHF care in Spain because the study analyzed all patients who were admitted for AHF&#44; including those discharged from the HED and who presumably showed milder AHF&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In our analysis&#44; the profile of a patient with AHF is that of an individual older than 75 years&#44; with high comorbidity&#46; When categorizing AHF as NOAHF or CDHF&#44; we observed that the NOAHF group had lower comorbidity&#44; had a better functional condition and were administered fewer drugs&#46; Due to the large sample size&#44; many of the differences observed between NOAHF and CDHF were statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; although their clinical significance might not be relevant&#46; We attribute the results to the fact that patients with NOAHF are in an earlier stage of the disease&#39;s natural history&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In terms of the characteristics of the acute episode&#44; patients with NOAHF present higher blood pressure and heart rate levels upon arrival at the HED&#44; possibly because they are not undergoing prior drug therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> However&#44; previous studies have shown that preserved or high blood pressure readings during an AHF episode are associated with a better prognosis&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> which is consistent with that observed in our study&#46; The patients with CDHF presented poorer laboratory test results&#44; except for troponin values&#46; However&#44; troponin levels were only measured in half of the patients because the indication for measuring cardiac troponin in HF was subsequent to the inclusion of a number of patients&#44; and compliance with this recommendation is not optimal&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> Moreover&#44; the measurement of B-type natriuretic peptide was low&#46; Once again&#44; low compliance with the guidelines could be one of the explanations&#44; as well as the lack of availability of this biomarker in some HEDs&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> This fact is especially relevant for patients with NOAHF&#44; given the recommendation for always measuring this biomarker in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Our results also suggest that the patients with CDHF presented greater severity because their baseline saturation was lower and more often required oxygen therapy&#44; invasive and noninvasive ventilation&#44; and infusions of drugs &#40;diuretics&#44; inotropic agents and nitrates&#41;&#46; Infection was the most common trigger in the 2 groups&#44; followed by rapid atrial fibrillation&#44; which was more common in the patients with NOAHF&#44; possibly because many of the patients with CDHF were treated with drugs that slowed the heart rate&#46; Coronary ischemia was also more common in the patients with NOAHF&#44; although it occurred in only 5&#37; of these patients&#46; This result is worth discussing because previous studies that suggested a poorer prognosis for patients with NOAHF showed an overall incidence rate of acute myocardial infarction of approximately 30&#37; and always higher in the NOAHF group&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5&#8211;7&#44;15</span></a> The excess mortality in this group could therefore be related to the trigger &#40;coronary ischemia&#41; and not to HF&#46; We attribute the difference between these studies and ours to &#40;a&#41; the fact that the EAHFE registry excludes patients with STE-ACS on their arrival at the HED and &#40;b&#41; to the fact that the previous studies were conducted in cardiology or intensive care departments&#44; where patients with coronary ischemia are more frequently admitted&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In terms of the patients&#8217; destination&#44; 6457 were hospitalized &#40;74&#46;7&#37;&#41;&#44; a result similar to previous studies in which the figure ranged from 64&#37; &#40;Canada&#41; to 84&#37; &#40;US&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> The patients with CDHF presented a greater need for hospitalization&#44; probably due to their greater comorbidity and poorer functional status&#46; The number of ICU admissions was higher for the patients with NOAHF despite presenting less severity&#44; which could be due to &#40;a&#41; the rate of coronary ischemia as the episode trigger&#44; a more common event for patients with NOAHF and &#40;b&#41; the fact that a number patients with CDHF were likely not admitted to ICUs due to their poorer functional profile&#44; age and degree of dependence&#46; It is notable that the most common destination for the patients with NOAHF was the internal medicine ward and not cardiology&#44; as recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a> This result could be due to the study population&#39;s characteristics and the availability of hospital beds&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In terms of prognosis&#44; the differences in hospital mortality were not statistically significant&#44; A result that differs from that of other published studies where patients with NOAHF presented greater hospital mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#44;7</span></a> Our study did not include patients with STE-ACS&#44; a more common trigger than cardiogenic shock&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> which could explain this result&#46; Crude mortality at 1 year was higher for the patients with CDHF&#46; This result has been observed in previous studies<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">14&#44;15&#44;19&#44;20</span></a> and can be attributed to a more advanced phase in the disease&#39;s natural history&#44; greater comorbidity and poorer baseline functional status&#46; In fact&#44; this reduction in risk is corrected in the model with overall fit&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The crude and adjusted readmission rates for AHF at 30 days postdischarge were lower for NOAHF&#46; However&#44; we can hypothesize that when treating patients with better functional status and lower comorbidity&#44; some of the readmissions can occur in primary care or emergency care systems other than HEDs&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">It is worth mentioning our study&#39;s limitations&#44; which include the exclusion of patients with AHF associated with STE-ACS&#44; The lack of information on the causes of death and the fact that clinical diagnoses were employed for including patients with HF&#59; however&#44; this reflects the clinical practice in our setting&#46; Healthcare data regarding the phase of prehospital emergency care were not collected&#46; These data might have affected the prognosis<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">12&#44;21</span></a> and could differ between the patients with and without a history of HF&#46; Finally&#44; given that this was a secondary analysis&#44; there was no prior calculation of the sample size&#44; and we cannot therefore rule out a second species error in a number of the estimates&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">Patients admitted to an HED for NOAHF presented a clinical profile different from that of patients with CDHF&#46; In the adjusted analysis&#44; there were no differences between the 2 groups regarding short and long-term mortality&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">The present study was made possible in part thanks to grants <span class="elsevierStyleGrantNumber" refid="gs1">PI15&#47;01019</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs1">PI15&#47;00773</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs1">PI18&#47;00393</span> and <span class="elsevierStyleGrantNumber" refid="gs1">PI18&#47;00456</span> of the Carlos III Health Institute from funds from the <span class="elsevierStyleGrantSponsor" id="gs1">Ministry of Health&#44; Social Services and Equality &#40;MSSSI&#41;</span> and <span class="elsevierStyleGrantSponsor" id="gs2">European Regional Development Fund &#40;ERDF&#41;</span>&#44; to grants from the <span class="elsevierStyleGrantSponsor" id="gs3">Government of Catalonia for Consolidated Research Groups</span> &#40;GRC <span class="elsevierStyleGrantNumber" refid="gs3">2009&#47;1385</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs3">2014&#47;0313</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs3">2017&#47;1424</span>&#41; and to a grant from the <span class="elsevierStyleGrantSponsor" id="gs4">La Marat&#243; Foundation of TV3</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs4">2015&#47;2510</span>&#41;&#46; The ICA-SEMES group received unconditional assistance from Orion-Pharma&#44; Otsuka and Novartis Spain&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the clinical characteristics and prognosis &#40;hospital mortality at 30 days and 12 months and emergency department readmission at 30 days for acute heart failure&#41; of patients treated in hospital emergency departments for new-onset or de novo acute heart failure &#40;NOAHF&#41; and to compare the patients with those who consult for chronic decompensated heart failure &#40;CDHF&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">NOVICA is a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments registry&#46; We compared demographic variables&#44; baseline characteristics and data from acute episodes and follow-up at 30 days and 12 months of patients with NOAHF and CDHF&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We analyzed 8647 patients&#44; with 3288 cases of NOAHF &#40;38&#37;&#41; and 5359 cases of CDHF &#40;62&#37;&#41;&#46; NOAHF was associated with lower comorbidity&#44; better baseline state&#44; less severe acute episode data&#44; less use of diuretics in intravenous infusion and oxygen therapy and lower hospitalization rates&#46; The patients with NOAHF were admitted more often to cardiology and intensive care units&#44; and the patients with CDHF were admitted more often to short-stay units&#46; Rates of crude mortality at 30 days and 12 months and readmission at 30 days were higher for the patients with NOAHF&#46; In the adjusted analysis&#44; however&#44; only the rate of readmission at 30 days was lower for NOAHF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients admitted to hospital emergency departments for NOAHF show a different clinical profile from patients with CDHF&#46; In the adjusted analysis&#44; there were no differences between the 2 groups regarding hospital mortality&#44; 30-day mortality or 12-month mortality&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas cl&#237;nicas y el pron&#243;stico-mortalidad intrahospitalaria&#44; a 30 d&#237;as y a 12 meses y reconsulta en urgencias a 30 d&#237;as por insuficiencia cardiaca aguda-de pacientes atendidos en servicios de urgencias hospitalarios por insuficiencia cardiaca aguda de nueva aparici&#243;n o de novo &#40;ICAN&#41; y compararlas con los que consultan por insuficiencia cardiaca cr&#243;nica descompensada &#40;ICAD&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">NOVICA es un an&#225;lisis secundario del registro Epidemiology of Acute Heart Failure in Emergency Departments&#46; Se compararon variables demogr&#225;ficas&#44; caracter&#237;sticas basales&#44; datos del episodio agudo y seguimiento a 30 d&#237;as y al a&#241;o de pacientes con ICAN e ICAD&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 8647 pacientes&#44; 3288 ICAN &#40;38&#37;&#41; y 5359 ICAD &#40;62&#37;&#41;&#46; Las ICAN asociaron menor comorbilidad&#44; mejor estado basal&#44; datos de menor gravedad del episodio agudo&#58; menor uso de diur&#233;ticos en perfusi&#243;n intravenosa y de oxigenoterapia&#44; menor tasa de hospitalizaci&#243;n&#46; Las ICAN ingresaron m&#225;s frecuentemente en cardiolog&#237;a o unidades de cuidados intensivos y las ICAD en unidades de corta estancia&#46; La mortalidad cruda a 30 d&#237;as y a 12 meses y la reconsulta a 30 d&#237;as fueron inferiores en pacientes con ICAN&#46; No obstante&#44; en el an&#225;lisis ajustado solo la reconsulta a 30 d&#237;as fue inferior en las ICAN &#40;p&#60;0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los pacientes que consultan en servicios de urgencias hospitalarios por ICAN muestran un perfil cl&#237;nico diferente a los pacientes con ICAD&#46; En los an&#225;lisis ajustados&#44; no hay diferencias entre los dos grupos en relaci&#243;n a mortalidad intrahospitalaria&#44; a 30 d&#237;as ni a 12 meses&#46;</p></span>"
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            "identificador" => "abst0025"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Garc&#237;a Sarasola A&#44; Alqu&#233;zar Arb&#233; A&#44; Gil V&#44; Mart&#237;n-S&#225;nchez FJ&#44; Jacob J&#44; Llorens P&#44; et al&#46; NOVICA&#58; caracter&#237;sticas y evoluci&#243;n en los pacientes que presentan un primer episodio de insuficiencia cardiaca &#40;de novo&#41;&#46; Rev Clin Esp&#46; 2019&#59;219&#58;469&#8211;476&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Survival curves &#40;Kaplan&#8211;Maier&#41; for the 2 study groups&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ACEI&#44; angiotensin-converting enzyme inhibitor&#59; ARB II&#44; angiotensin II receptor blocker&#59; NYHA&#44; New York Heart Association&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">p</span> values in bold indicate those differences that were considered statistically significant&#46;</p>"
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                  \t\t\t\t">1260 &#40;38&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">547 &#40;16&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1461 &#40;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cerebrovascular disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1092 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">391 &#40;11&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">701 &#40;13&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;106&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Atrial fibrillation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4146 &#40;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1171 &#40;35&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2975 &#40;55&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Valvular heart disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23&#44;358 &#40;27&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">612 &#40;18&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1746 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Peripheral artery disease</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">735 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">239 &#40;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">496 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Chronic obstructive pulmonary disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2179 &#40;25&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;0&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">684 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1495 &#40;27&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Dementia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">895 &#40;12&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1336 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">352 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">543 &#40;12&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;638&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neoplasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">925 &#40;12&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1336 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">382 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">543 &#40;12&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;412&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Baseline situation</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean Barthel Index&#44; &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">78&#46;9 &#40;25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1209 &#40;14&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83&#46;1 &#40;24&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">76&#46;4 &#40;25&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">NYHA class III&#8211;IV</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2001 &#40;23&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">618 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">430 &#40;13&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1571 &#40;29&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Long-term therapy</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Loop diuretics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5551 &#40;67&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">364 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1413 &#40;44&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4138 &#40;80&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">454 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1492 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">184 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">270 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;788&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hypertensive crisis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">459 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1494 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">202 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">257 &#40;6&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;066&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Therapeutic or dietary noncompliance</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">259 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1494 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">187 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Coronary ischemia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">300 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1494 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">146 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">154 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Vital signs during the acute episode</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean systolic blood pressure&#44; mm Hg</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">142&#46;1 &#40;28&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">173 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">144&#46;5 &#40;28&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">140&#46;6 &#40;28&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean heart rate&#44; bpm &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">89&#46;3 &#40;24&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">245 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">92&#46;9 &#40;26&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">87&#46;1 &#40;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean baseline oxygen saturation&#44; &#37; &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">91&#46;9 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">386 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">92&#46;3 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">91&#46;9 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Electrocardiogram</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Atrial fibrillation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3679 &#40;48&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1040 &#40;12&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1295 &#40;43&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2384 &#40;51&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Left ventricular hypertrophy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">341 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1038 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">220 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;166&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Left bundle-branch block</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">786 &#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1040 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">254 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">532 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Laboratory data during the acute episode</span></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean blood glucose&#44; mg&#47;dL &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149&#46;2 &#40;69&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Original article
NOVICA: Characteristics and outcomes of patients who have a first episode of heart failure (de novo)
NOVICA: características y evolución en los pacientes que presentan un primer episodio de insuficiencia cardiaca (de novo)
A. García Sarasolaa, A. Alquézar Arbéa, V. Gilb, F.J. Martín-Sánchezc, J. Jacobd, P. Llorense, M. Rizzia, C. Fuenzalidab, S. Calderónb, Ò. Mirób,
Corresponding author
omiro@clinic.cat

Corresponding author.
a Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
b Área de Urgencias, Hospital Clínic, Barcelona, Barcelona, Spain
c Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Universidad Complutense de Madrid, Madrid, Spain
d Servicio de Urgencias, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
e Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acute heart failure &#40;AHF&#41; is the rapid onset or worsening of the signs and symptoms of heart failure &#40;HF&#41; and usually requires emergency care&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> In Spain&#44; AHF is the leading cause of hospitalization for individuals older than 65 years&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">2</span></a> although 24&#37; of patients with AHF are discharged from hospital emergency departments &#40;HEDs&#41; without requiring hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">3</span></a> Likewise&#44; 30&#37; of patients admitted for AHF die at 1 year of the hospitalization&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> Based on the temporal progression of AHF&#44; we can classify AHF into 2 categories&#58; new onset or de novo AHF &#40;NOAHF&#41;&#44; which presents in patients with an initial AHF decompensation&#44; and chronic decompensated HF &#40;CDHF&#41;&#44; which corresponds to an exacerbation of HF symptoms in patients with at least one previous decompensation&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> Previous studies have shown greater hospital mortality for patients with NOAHF&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5&#8211;7</span></a> Hospitalization is therefore recommended for individuals with this condition&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">8&#44;9</span></a> However&#44; these studies included patients hospitalized in cardiology wards and intensive care units&#46; These hospital units usually present a high incidence of patients with NOAHF in the context of an acute myocardial infarction as the trigger for the acute episode&#46; These patients therefore have more severe clinical presentations such as cardiogenic shock&#46; In this context&#44; knowledge of this potential risk factor needs to be deepened&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The aims of our study were to describe the clinical characteristics of and the clinical approach for patients treated in HEDs for NOAHF and to compare them with patients admitted for CDHF&#46; The study also aimed to assess the prognosis of patients with NOAHF compared with patients with CDHF in terms of survival &#40;hospital&#44; 30-day and 12-month&#41; and 30-day readmission for AHF in HEDs&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">The de novo Acute Heart Failure study &#40;<span class="elsevierStyleItalic">Insuficiencia Cardiaca Aguda de novo</span>&#44; NOVICA&#41; is a retrospective analysis of the Epidemiology of Acute Heart Failure in Emergency Departments &#40;EAHFE&#41; registry&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> a multicenter&#44; multipurpose&#44; analytical&#44; noninterventional registry&#44; with a prospective follow-up that consecutively includes all patients treated for AHF in 34 Spanish HEDs&#46; The inclusion criteria were compliance with the AHF diagnostic criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a> Whenever possible&#44; the diagnosis was confirmed by measuring natriuretic peptide levels or performing an echocardiogram&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> Patients with AHF in the context of an acute coronary syndrome with ST-segment elevation &#40;STE-ACS&#41; were excluded&#46; The EAHFE Registry complies with the Declaration of Helsinki&#44; and all patients signed an informed consent document&#46; The protocol was approved by the Clinical Research Ethics Committees of the participating hospitals&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study included patients from EAHFE-1 &#40;2007&#41; to EAHFE-4 &#40;2014&#41;&#46; The data collection method was similar for the 4 periods and has been previously published&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10&#44;12</span></a> The study included all patients who had the study variable&#58; a first episode of AHF or decompensated HF in patients with a previous episode of AHF&#44; differentiating between NOAHF and CDHF&#46; Patients were considered to have NOAHF if they had an initial decompensated AHF that required emergency care&#46; This information was obtained from an anamnesis directed at the patient or relatives&#44; and there were no previous episodes with a diagnosis of heart failure in the medical history review&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We collected demographic variables&#44; personal history&#44; baseline functional state&#44; previous long-term therapy&#44; episode triggers&#44; vital signs during the acute episode&#44; complementary tests&#44; treatment administered in the emergency department and the episode outcome&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The primary endpoint was all-cause mortality during the year following the emergency department admission for the index event&#46; The secondary endpoints were hospital mortality during the index event&#44; 30-day mortality&#44; 12-month mortality and HED readmission for AHF at 30 days of the discharge&#46; This information was verified by telephone calls and by consulting the electronic medical record at 30 days&#44; 90 days and after a year&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the statistical analysis&#44; the quantitative variables are expressed as mean and standard deviation &#40;SD&#41;&#44; and the qualitative variables are expressed as absolutes and percentages&#46; The univariate analysis of the quantitative variables employed Student&#39;s <span class="elsevierStyleItalic">t</span>-test and the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test for the variables that did not follow a normal distribution according to the Kolmogorov&#8211;Smirnov test&#46; The qualitative variables were analyzed with the chi-squared test and Fisher&#39;s exact text&#44; as necessary&#46; To assess the prognostic value of NOAHF in terms of 30-day readmission&#44; hospital mortality and 30-day mortality&#44; we compared the effects of the NOAHF variable to those of CDHF&#44; expressed as the crude odds ratio &#40;OR&#41; with its 95&#37; confidence interval &#40;95&#37; CI&#41;&#46; The results were subsequently adjusted using a logistic regression analysis that included all variables with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05 in the univariate analysis&#46; We performed 3 separate fit models using the insertion method&#58; the first by the differences in the baseline characteristics&#44; the second by the differences in the acute episode and the third by the 2 previous models simultaneously&#46; To assess the prognostic value of NOAHF in terms of 12-month survival&#44; we created survival curves according to the Kaplan&#8211;Meier method&#44; comparing them with the log-rank test&#46; We also calculated the crude hazard ratio &#40;HR&#41; and its 95&#37; CI using the Cox regression method and then adjusted it based on the same strategy described for OR&#46; For all comparisons&#44; we accepted that the differences were statistically significant when the <span class="elsevierStyleItalic">p</span>-value was &#60;&#46;05 or when the 95&#37; CI of the HR or the OR excluded the value 1&#46; The statistical analysis was conducted with the SPSS 24&#46;0 program for Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Of the 9078 patients included in the EAHFE 1&#8211;4&#44; the NOVICA study included 8647 patients&#46; The study excluded 431 &#40;4&#46;74&#37;&#41; for lacking information on the chronology of the episode &#40;first episode or decompensation&#41;&#44; and the rest were classified as NOAHF &#40;3288&#44; 38&#37;&#41; or CDHF &#40;5359&#44; 62&#37;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the patients&#8217; baseline characteristics&#46; The patients with CDHF were older and had a higher prevalence of practically all analyzed comorbidities&#44; as well as a poorer baseline status&#46; Likewise&#44; the patients with CDHF underwent treatment more frequently with most of the drugs studied&#44; except for thiazide diuretics and ARB-II&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the data regarding the AHF episode&#46; Overall&#44; infection was the most common trigger&#46; We can observe that atrial fibrillation and coronary ischemia were more common in the patients with NOAHF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; and that infection and therapeutic noncompliance were more common in the patients with CDHF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; There was a notably higher use of invasive ventilation and continuous intravenous infusions in the patient group with CDHF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; Of the total&#44; 6457 patients were hospitalized &#40;74&#46;7&#37;&#41;&#46; The most common destination for both groups was internal medicine&#44; with no statistically significant differences between them &#40;NOAHF 30&#46;7&#37;&#44; CDHF 33&#46;5&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;19&#41;&#46; The patients with NOAHF were admitted more often to cardiology departments and intensive care units &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; and the patients with CDHF were more often admitted to short-stay units &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In terms of prognosis&#44; mortality and readmission at 30 days for AHF&#44; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the unadjusted results&#46; At 1 year of the emergency department admission for AHF&#44; 507 patients with NOAHF died &#40;11&#46;7&#37;&#41;&#44; compared with 1150 patients &#40;32&#46;9&#37;&#41; with CDHF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the crude survival curves&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the prognosis&#44; crude and adjusted survival &#40;hospital&#44; 30-day and 1-year&#41; and HED readmission for AHF at 30 days&#46; We performed adjusted models for the differences in the baseline characteristics &#40;model A&#41;&#44; for the differences in the episode characteristics &#40;model B&#41; and for all differences between the 2 groups &#40;model C&#41;&#46; In the models adjusted for all variables &#40;model C&#41;&#44; there were no differences in mortality&#44; but there were differences for 30-day readmission for AHF&#44; which was lower for the patients with NOAHF &#40;OR&#44; 0&#46;756&#59; 95&#37; CI 0&#46;667&#8211;0&#46;869&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">NOVICA is the first study in Spain to investigate the characteristics and outcomes of patients who are admitted to HEDs for AHF based on whether this involved a first episode or a decompensation&#46; Similar previous publications have employed smaller samples and were conducted with hospitalized patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5&#8211;7&#44;13&#8211;15</span></a> We believe these results are representative of the current reality of AHF care in Spain because the study analyzed all patients who were admitted for AHF&#44; including those discharged from the HED and who presumably showed milder AHF&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In our analysis&#44; the profile of a patient with AHF is that of an individual older than 75 years&#44; with high comorbidity&#46; When categorizing AHF as NOAHF or CDHF&#44; we observed that the NOAHF group had lower comorbidity&#44; had a better functional condition and were administered fewer drugs&#46; Due to the large sample size&#44; many of the differences observed between NOAHF and CDHF were statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; although their clinical significance might not be relevant&#46; We attribute the results to the fact that patients with NOAHF are in an earlier stage of the disease&#39;s natural history&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In terms of the characteristics of the acute episode&#44; patients with NOAHF present higher blood pressure and heart rate levels upon arrival at the HED&#44; possibly because they are not undergoing prior drug therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> However&#44; previous studies have shown that preserved or high blood pressure readings during an AHF episode are associated with a better prognosis&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> which is consistent with that observed in our study&#46; The patients with CDHF presented poorer laboratory test results&#44; except for troponin values&#46; However&#44; troponin levels were only measured in half of the patients because the indication for measuring cardiac troponin in HF was subsequent to the inclusion of a number of patients&#44; and compliance with this recommendation is not optimal&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> Moreover&#44; the measurement of B-type natriuretic peptide was low&#46; Once again&#44; low compliance with the guidelines could be one of the explanations&#44; as well as the lack of availability of this biomarker in some HEDs&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> This fact is especially relevant for patients with NOAHF&#44; given the recommendation for always measuring this biomarker in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Our results also suggest that the patients with CDHF presented greater severity because their baseline saturation was lower and more often required oxygen therapy&#44; invasive and noninvasive ventilation&#44; and infusions of drugs &#40;diuretics&#44; inotropic agents and nitrates&#41;&#46; Infection was the most common trigger in the 2 groups&#44; followed by rapid atrial fibrillation&#44; which was more common in the patients with NOAHF&#44; possibly because many of the patients with CDHF were treated with drugs that slowed the heart rate&#46; Coronary ischemia was also more common in the patients with NOAHF&#44; although it occurred in only 5&#37; of these patients&#46; This result is worth discussing because previous studies that suggested a poorer prognosis for patients with NOAHF showed an overall incidence rate of acute myocardial infarction of approximately 30&#37; and always higher in the NOAHF group&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">5&#8211;7&#44;15</span></a> The excess mortality in this group could therefore be related to the trigger &#40;coronary ischemia&#41; and not to HF&#46; We attribute the difference between these studies and ours to &#40;a&#41; the fact that the EAHFE registry excludes patients with STE-ACS on their arrival at the HED and &#40;b&#41; to the fact that the previous studies were conducted in cardiology or intensive care departments&#44; where patients with coronary ischemia are more frequently admitted&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In terms of the patients&#8217; destination&#44; 6457 were hospitalized &#40;74&#46;7&#37;&#41;&#44; a result similar to previous studies in which the figure ranged from 64&#37; &#40;Canada&#41; to 84&#37; &#40;US&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> The patients with CDHF presented a greater need for hospitalization&#44; probably due to their greater comorbidity and poorer functional status&#46; The number of ICU admissions was higher for the patients with NOAHF despite presenting less severity&#44; which could be due to &#40;a&#41; the rate of coronary ischemia as the episode trigger&#44; a more common event for patients with NOAHF and &#40;b&#41; the fact that a number patients with CDHF were likely not admitted to ICUs due to their poorer functional profile&#44; age and degree of dependence&#46; It is notable that the most common destination for the patients with NOAHF was the internal medicine ward and not cardiology&#44; as recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">8</span></a> This result could be due to the study population&#39;s characteristics and the availability of hospital beds&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In terms of prognosis&#44; the differences in hospital mortality were not statistically significant&#44; A result that differs from that of other published studies where patients with NOAHF presented greater hospital mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#44;7</span></a> Our study did not include patients with STE-ACS&#44; a more common trigger than cardiogenic shock&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">6</span></a> which could explain this result&#46; Crude mortality at 1 year was higher for the patients with CDHF&#46; This result has been observed in previous studies<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">14&#44;15&#44;19&#44;20</span></a> and can be attributed to a more advanced phase in the disease&#39;s natural history&#44; greater comorbidity and poorer baseline functional status&#46; In fact&#44; this reduction in risk is corrected in the model with overall fit&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The crude and adjusted readmission rates for AHF at 30 days postdischarge were lower for NOAHF&#46; However&#44; we can hypothesize that when treating patients with better functional status and lower comorbidity&#44; some of the readmissions can occur in primary care or emergency care systems other than HEDs&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">It is worth mentioning our study&#39;s limitations&#44; which include the exclusion of patients with AHF associated with STE-ACS&#44; The lack of information on the causes of death and the fact that clinical diagnoses were employed for including patients with HF&#59; however&#44; this reflects the clinical practice in our setting&#46; Healthcare data regarding the phase of prehospital emergency care were not collected&#46; These data might have affected the prognosis<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">12&#44;21</span></a> and could differ between the patients with and without a history of HF&#46; Finally&#44; given that this was a secondary analysis&#44; there was no prior calculation of the sample size&#44; and we cannot therefore rule out a second species error in a number of the estimates&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0100" class="elsevierStylePara elsevierViewall">Patients admitted to an HED for NOAHF presented a clinical profile different from that of patients with CDHF&#46; In the adjusted analysis&#44; there were no differences between the 2 groups regarding short and long-term mortality&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">The present study was made possible in part thanks to grants <span class="elsevierStyleGrantNumber" refid="gs1">PI15&#47;01019</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs1">PI15&#47;00773</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs1">PI18&#47;00393</span> and <span class="elsevierStyleGrantNumber" refid="gs1">PI18&#47;00456</span> of the Carlos III Health Institute from funds from the <span class="elsevierStyleGrantSponsor" id="gs1">Ministry of Health&#44; Social Services and Equality &#40;MSSSI&#41;</span> and <span class="elsevierStyleGrantSponsor" id="gs2">European Regional Development Fund &#40;ERDF&#41;</span>&#44; to grants from the <span class="elsevierStyleGrantSponsor" id="gs3">Government of Catalonia for Consolidated Research Groups</span> &#40;GRC <span class="elsevierStyleGrantNumber" refid="gs3">2009&#47;1385</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs3">2014&#47;0313</span>&#44; <span class="elsevierStyleGrantNumber" refid="gs3">2017&#47;1424</span>&#41; and to a grant from the <span class="elsevierStyleGrantSponsor" id="gs4">La Marat&#243; Foundation of TV3</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs4">2015&#47;2510</span>&#41;&#46; The ICA-SEMES group received unconditional assistance from Orion-Pharma&#44; Otsuka and Novartis Spain&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Resumen"
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              "titulo" => "Antecedentes y objetivos"
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          "titulo" => "Palabras clave"
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          "titulo" => "Background"
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    "fechaRecibido" => "2019-02-03"
    "fechaAceptado" => "2019-04-24"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Acute heart failure"
            1 => "Mortality"
            2 => "Readmission"
            3 => "Emergency department"
          ]
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      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1176783"
          "palabras" => array:4 [
            0 => "Insuficiencia cardiaca aguda"
            1 => "Mortalidad"
            2 => "Reconsulta"
            3 => "Urgencias"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the clinical characteristics and prognosis &#40;hospital mortality at 30 days and 12 months and emergency department readmission at 30 days for acute heart failure&#41; of patients treated in hospital emergency departments for new-onset or de novo acute heart failure &#40;NOAHF&#41; and to compare the patients with those who consult for chronic decompensated heart failure &#40;CDHF&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">NOVICA is a secondary analysis of the Epidemiology of Acute Heart Failure in Emergency Departments registry&#46; We compared demographic variables&#44; baseline characteristics and data from acute episodes and follow-up at 30 days and 12 months of patients with NOAHF and CDHF&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We analyzed 8647 patients&#44; with 3288 cases of NOAHF &#40;38&#37;&#41; and 5359 cases of CDHF &#40;62&#37;&#41;&#46; NOAHF was associated with lower comorbidity&#44; better baseline state&#44; less severe acute episode data&#44; less use of diuretics in intravenous infusion and oxygen therapy and lower hospitalization rates&#46; The patients with NOAHF were admitted more often to cardiology and intensive care units&#44; and the patients with CDHF were admitted more often to short-stay units&#46; Rates of crude mortality at 30 days and 12 months and readmission at 30 days were higher for the patients with NOAHF&#46; In the adjusted analysis&#44; however&#44; only the rate of readmission at 30 days was lower for NOAHF &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patients admitted to hospital emergency departments for NOAHF show a different clinical profile from patients with CDHF&#46; In the adjusted analysis&#44; there were no differences between the 2 groups regarding hospital mortality&#44; 30-day mortality or 12-month mortality&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objectives"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas cl&#237;nicas y el pron&#243;stico-mortalidad intrahospitalaria&#44; a 30 d&#237;as y a 12 meses y reconsulta en urgencias a 30 d&#237;as por insuficiencia cardiaca aguda-de pacientes atendidos en servicios de urgencias hospitalarios por insuficiencia cardiaca aguda de nueva aparici&#243;n o de novo &#40;ICAN&#41; y compararlas con los que consultan por insuficiencia cardiaca cr&#243;nica descompensada &#40;ICAD&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">NOVICA es un an&#225;lisis secundario del registro Epidemiology of Acute Heart Failure in Emergency Departments&#46; Se compararon variables demogr&#225;ficas&#44; caracter&#237;sticas basales&#44; datos del episodio agudo y seguimiento a 30 d&#237;as y al a&#241;o de pacientes con ICAN e ICAD&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 8647 pacientes&#44; 3288 ICAN &#40;38&#37;&#41; y 5359 ICAD &#40;62&#37;&#41;&#46; Las ICAN asociaron menor comorbilidad&#44; mejor estado basal&#44; datos de menor gravedad del episodio agudo&#58; menor uso de diur&#233;ticos en perfusi&#243;n intravenosa y de oxigenoterapia&#44; menor tasa de hospitalizaci&#243;n&#46; Las ICAN ingresaron m&#225;s frecuentemente en cardiolog&#237;a o unidades de cuidados intensivos y las ICAD en unidades de corta estancia&#46; La mortalidad cruda a 30 d&#237;as y a 12 meses y la reconsulta a 30 d&#237;as fueron inferiores en pacientes con ICAN&#46; No obstante&#44; en el an&#225;lisis ajustado solo la reconsulta a 30 d&#237;as fue inferior en las ICAN &#40;p&#60;0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los pacientes que consultan en servicios de urgencias hospitalarios por ICAN muestran un perfil cl&#237;nico diferente a los pacientes con ICAD&#46; En los an&#225;lisis ajustados&#44; no hay diferencias entre los dos grupos en relaci&#243;n a mortalidad intrahospitalaria&#44; a 30 d&#237;as ni a 12 meses&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Garc&#237;a Sarasola A&#44; Alqu&#233;zar Arb&#233; A&#44; Gil V&#44; Mart&#237;n-S&#225;nchez FJ&#44; Jacob J&#44; Llorens P&#44; et al&#46; NOVICA&#58; caracter&#237;sticas y evoluci&#243;n en los pacientes que presentan un primer episodio de insuficiencia cardiaca &#40;de novo&#41;&#46; Rev Clin Esp&#46; 2019&#59;219&#58;469&#8211;476&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Survival curves &#40;Kaplan&#8211;Maier&#41; for the 2 study groups&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Crude and adjusted survival analysis and readmission of patients with NOAHF compared with patients with ADHF&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ACEI&#44; angiotensin-converting enzyme inhibitor&#59; ARB II&#44; angiotensin II receptor blocker&#59; NYHA&#44; New York Heart Association&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">p</span> values in bold indicate those differences that were considered statistically significant&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8647&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lost values&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">De novo AHF <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3288&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Decompensated AHF <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5359&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t">735 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">239 &#40;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">496 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Chronic obstructive pulmonary disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1495 &#40;27&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Dementia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Neoplasia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">543 &#40;12&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;412&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Baseline situation</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean Barthel Index&#44; &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1209 &#40;14&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">NYHA class III&#8211;IV</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1571 &#40;29&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Loop diuretics</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Thiazide diuretics</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ACEI</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2871 &#40;34&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">948 &#40;30&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1923 &#40;37&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ARB II</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;519&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">3047 &#40;37&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">363 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">953 &#40;30&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2121 &#40;41&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean systolic blood pressure&#44; mm Hg</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142&#46;1 &#40;28&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">173 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144&#46;5 &#40;28&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140&#46;6 &#40;28&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean heart rate&#44; bpm &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;3 &#40;24&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">245 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;9 &#40;26&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;1 &#40;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean baseline oxygen saturation&#44; &#37; &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;9 &#40;6&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">386 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;3 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;9 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Electrocardiogram</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Atrial fibrillation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3679 &#40;48&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1040 &#40;12&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1295 &#40;43&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2384 &#40;51&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Left ventricular hypertrophy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">341 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1038 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">220 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;166&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Left bundle-branch block</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">786 &#40;10&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1040 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">254 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">532 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Laboratory data during the acute episode</span></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean blood glucose&#44; mg&#47;dL &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149&#46;2 &#40;69&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1574 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147&#46;4 &#40;68&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&#46;3 &#40;69&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;085<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean creatinine&#44; mg&#47;dL &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3 &#40;0&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">155 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9 &#40;0&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;4 &#40;0&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean hemoglobin&#44; g&#47;dL &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;9 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;2 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;8 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mean sodium&#44; mEq&#47;L &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137&#46;6 &#40;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">261 &#40;3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137&#46;9 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137&#46;5 &#40;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">High natriuretic peptide levels</span><a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2021 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Original language: English
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