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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0055" class="elsevierStylePara elsevierViewall">Heart failure &#40;HF&#41; is a major global burden in terms of patients&#8217; quality and duration of life and of health expenditure&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#8211;4</span></a> Approximately 1-2&#37; of the adult population in developed countries has HF&#44; the prevalence rising to &#8805;10&#37; among those 70 years of age or older&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;5&#44;6</span></a> In Portugal&#44; the overall prevalence of chronic HF was 4&#46;36&#37; in a community-based epidemiological survey carried out in 1998&#44; rising sharply with age&#59; this was slightly higher than that of other European countries&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Across the globe&#44; 17-45&#37; of patients hospitalized with HF die within a year of hospitalization<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;8</span></a> and a quarter are rehospitalized within one month and up to two-thirds within a year&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;8&#8211;10</span></a> HF is the most common reason for hospitalization in people over 65 years of age in economically developed regions&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">6&#44;9&#44;11&#8211;13</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">According to national registries of the Portuguese Directorate-General of Health&#44; in 2014 18 588 patients were hospitalized for HF and the in-hospital mortality rate was 12&#46;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The increasing incidence of acute HF and associated morbidity and mortality mean there is an urgent need to better understand this patient population&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a> Despite the high prevalence of acute HF&#44; few studies have been conducted specifically in the hospitalized HF population&#44; and data on clinical characteristics and outcomes for these patients are lacking&#44; especially in Portugal&#46; Observational studies provide useful information about real-world patients and routine clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a> Interest in this type of research has been growing in recent decades&#44; for various reasons&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">According to the latest guidelines on heart failure&#44; the standard-of-care for HF patients recently hospitalized for acute de novo or chronic decompensated HF should include enrollment in a multidisciplinary care management program&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;16</span></a> also known as a heart failure clinic&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The present study covers the year before the implementation of an HF clinic&#44; using a multidisciplinary approach to HF patients&#44; in a Portuguese tertiary university hospital&#46; The study was designed to improve knowledge of the characteristics of patients hospitalized and treated for HF in an internal medicine department and to present one-year follow-up outcomes&#44; reporting in-hospital and one-year mortality and rehospitalization for HF&#44; which will help to evaluate the impact of our HF clinic on those outcomes&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study design and clinical setting</span><p id="par0085" class="elsevierStylePara elsevierViewall">This was a single-center retrospective observational study&#46; All patients hospitalized in the internal medicine department of a tertiary university hospital and discharged between January 1 and December 31&#44; 2012 were considered for enrollment&#46; The study population was selected using the International Classification of Diseases&#44; 9th Revision &#40;ICD-9&#41; codes&#44; as listed in the discharge summary&#46; All discharge summaries reporting one of the ICD-9 HF codes &#40;428&#44; 428&#46;0&#44; 428&#46;1&#44; 428&#46;2&#44; 428&#46;3&#44; 428&#46;4&#44; 428&#46;9&#44; 402&#46;01&#44; 402&#46;11&#44; 402&#46;91 or 398&#46;91&#41; in the first three codes were reviewed&#46; Based on review of the discharge summary&#44; patients were selected if they had been hospitalized for acute&#44; de novo or chronic decompensated HF as stated in their medical record&#44; and were aged 18 years or older&#46; HF was diagnosed according to European Society of Cardiology guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> All patients without an echocardiogram had relevant cardiac disease documented in their clinical record and NT-proBNP values higher than 1000 pg&#47;ml&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">For the purposes of the study&#44; the first hospitalization for acute HF in the study period was considered the index hospitalization&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data collection</span><p id="par0095" class="elsevierStylePara elsevierViewall">Data were collected based on discharge summaries&#44; medical records and telephone interviews&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The following data were collected from the discharge summary&#58; gender&#44; age&#44; risk factors for HF&#44; comorbidities&#44; functional status&#44; HF etiology&#44; decompensation trigger and treatment&#46; HF comorbidities considered for analysis were hypertension&#44; diabetes&#44; cerebrovascular disease&#44; peripheral arterial disease&#44; atrial fibrillation &#40;AF&#41;&#44; active cancer&#44; chronic lung disease&#44; sleep apnea and&#47;or hypoventilation syndrome&#44; and dementia&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Other clinical records were reviewed for biometric&#44; laboratory&#44; echocardiographic&#44; follow-up and rehospitalization data&#46; The etiology of cardiac disease was established through clinical data and echocardiography&#46; Only rehospitalizations at the study center were considered&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Mortality data were obtained through clinical records and telephone interviews&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Outcomes</span><p id="par0115" class="elsevierStylePara elsevierViewall">The main outcomes were the characteristics of the study population&#44; namely age&#44; gender&#44; comorbidities&#44; HF risk factors and etiology&#44; HF decompensation trigger&#44; left ventricular ejection fraction &#40;EF&#41;&#44; in-hospital mortality&#44; discharge treatments&#44; rehospitalization for decompensated HF and death in the year following discharge from the index hospitalization&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Study oversight</span><p id="par0120" class="elsevierStylePara elsevierViewall">The two lead authors prepared the manuscript&#44; and all authors reviewed it&#46; All the authors vouch for the accuracy and completeness of the data and analysis&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">Categorical variables are presented as percentages&#44; while continuous variables are presented as means and standard deviation &#40;SD&#41; plus median and interquartile range &#40;IQR&#41;&#46; Proportions were compared using the chi-square test for categorical variables&#46; The statistical analysis was performed using SPSS for Windows&#44; version 22&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patients and comorbidities</span><p id="par0130" class="elsevierStylePara elsevierViewall">In the study period 429 patients were identified and analyzed&#44; as depicted in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#46; The characteristics of the study group are reported in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Mean age was 79 years and the majority of patients were female &#40;62&#46;5&#37;&#41;&#46; The most prevalent comorbidity was hypertension&#44; followed by AF and diabetes&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">On average&#44; each patient had three comorbidities&#46; A third of patients had more than three comorbidities&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Regarding functional ability&#44; 96 patients &#40;22&#46;4&#37;&#41; had severe disability&#44; being completely dependent on a caregiver for their daily needs&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Heart failure</span><p id="par0145" class="elsevierStylePara elsevierViewall">Ischemic etiology of HF was recorded in 139 patients &#40;34&#46;6&#37;&#41; and valve disease in more than 74 &#40;18&#46;4&#37;&#41;&#44; of which severe aortic stenosis was the most common&#44; found in 27 patients &#40;6&#46;7&#37;&#41; &#40;data not shown&#41;&#46; An echocardiogram was available in 400 patients&#44; most of them with HF with preserved ejection fraction &#40;HFpEF&#41; &#40;70&#46;5&#37;&#41;&#44; defined as EF &#62;40&#37;&#44; and only 36 patients &#40;9&#37;&#41; had EF &#8804;25&#37;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The most frequent HF decompensation trigger was infection&#44; followed by non-adherence to treatment and rhythm disturbances &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; A trigger was not found in only two cases&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Non-invasive ventilation</span><p id="par0155" class="elsevierStylePara elsevierViewall">During hospital stay&#44; 80 patients &#40;18&#46;6&#37;&#41; were treated with non-invasive ventilation &#40;NIV&#41;&#44; 51&#37; of whom were not diagnosed with sleep apnea&#47;hypoventilation syndrome&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discharge medication</span><p id="par0160" class="elsevierStylePara elsevierViewall">At discharge&#44; 394 patients were alive and prescribed appropriate cardiovascular medications&#44; as reported in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; About half of the patients discharged were prescribed a beta-blocker and an angiotensin-converting enzyme &#40;ACE&#41; inhibitor or an angiotensin receptor blocker &#40;ARB&#41;&#46; Beta-blockers were prescribed significantly more frequently for patients with HF with reduced ejection fraction &#40;HFrEF&#41; but ACE inhibitors&#47;ARBs were not&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Oral anticoagulants were prescribed for 118 &#40;29&#46;9&#37;&#41; patients&#44; mainly to the 201 patients with a history of AF &#40;83&#46;1&#37;&#41;&#44; of whom 48&#46;8&#37; had anticoagulants prescribed at discharge&#44; while only 10&#46;4&#37; of those without AF received anticoagulation &#40;p&#60;0&#46;001&#41;&#46; This represents 20 patients anticoagulated for reasons other than AF&#44; mainly arterial peripheral disease&#44; venous thromboembolism&#44; previous ischemic stroke or mechanical prosthetic cardiac valves&#59; only two had a history of intracardiac thrombus &#40;data not shown&#41;&#46; The small number of patients prevents further statistical analysis&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Relation between ejection fraction and other clinical characteristics</span><p id="par0170" class="elsevierStylePara elsevierViewall">The relations between EF and characteristics including age&#44; gender&#44; HF etiology&#44; comorbidities&#44; plasma creatinine at admission and HF drug therapy prescribed at discharge are presented in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; Women presented a significantly higher proportion of HFpEF than men&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">Patients with diabetes and those with ischemic etiology had significantly higher proportions of HFrEF&#46; The HFrEF group were more frequently prescribed beta-blockers and spironolactone at discharge &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Age&#44; other comorbidities and plasma creatinine at admission were found to have no statistical relation with EF&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Follow-up outcomes</span><p id="par0180" class="elsevierStylePara elsevierViewall">In-hospital mortality was 7&#46;9&#37;&#46; Mortality in one-year follow-up was 34&#46;3&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A&#41;&#46; One patient was lost to follow-up after discharge&#46; The cause of death was established in 136 patients &#40;92&#46;5&#37; of deaths&#41; and a cardiovascular cause was found in 42&#46;9&#37; &#40;data not shown&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">Rehospitalization at least once for HF occurred in 30&#46;5&#37; of patients during the first year of follow-up&#44; within a median of 86 days &#40;IQR 176&#41; after discharge &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B&#41;&#46; The number of rehospitalizations per patient ranged between one and six &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">During the first year of follow-up after discharge&#44; 62&#37; of patients had an outpatient appointment with a cardiologist or an internist in our hospital&#46; It was not determined which patients were followed previously by one of these specialties or whether the appointment was scheduled prior to the HF hospitalization&#46; The median time between discharge and appointment was 63 days &#40;IQR 64&#46;5&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Regarding potential admission to our HF clinic&#44; 73&#37; of patients were considered candidates&#46; Referral to the clinic is considered for all patients hospitalized for acute HF&#46; Exclusion criteria are total dependence on caregivers for basic daily needs and inability to communicate&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0200" class="elsevierStylePara elsevierViewall">The main results of this study consist of the clinical findings of a large population hospitalized for HF in the internal medicine department of a tertiary university hospital&#46; In Portuguese hospitals&#44; many HF patients are treated by internists&#44; even in hospitals where there is a cardiology department&#44;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">18&#44;19</span></a> so this is a real-world survey&#44; enrolling all patients discharged following hospitalization due to acute or chronic decompensated HF during a one-year period&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Our patients are older&#44; more frequently female and more often with HFpEF than HF patients in other series&#44; who tend to be mainly hospitalized in cardiology departments&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2&#44;4</span></a> The mean age is similar to that reported in a recent French single-day survey in 170 hospitals of all patients hospitalized for acute HF&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> but 10 years older than in a recent Portuguese study enrolling patients hospitalized for acute HF only in the cardiology department of the other tertiary university hospital in the city where our study took place&#46; In that study 73&#46;2&#37; of patients had HFrEF&#44; which reflects considerable differences between the two study populations and is evidence of how observational studies provide valuable information about acute HF managed in different clinical scenarios&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">20&#44;21</span></a> Our data on gender are in agreement with other reports showing that elderly patients hospitalized with HF are mainly women<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> and that patients with HFpEF are older and more often female than those with HFrEF&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;5&#44;6&#44;8&#44;13</span></a> HF patients managed by internists are more likely to have the characteristics of those managed by general practitioners&#46; In the UK&#44; the mean age of HF patients in general practice is 77 years&#44; similar to that of our population&#46; The HF patient seen in general practice is generally 15 years older&#44; more often female&#44; more likely to have a history of hypertension and less likely to have had myocardial infarction than the HF patient seen by a cardiologist&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;6</span></a> It has been shown that in Portugal chronic HFpEF mainly affects older women<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> and that patients aged over 75 hospitalized for acute HF in an internal medicine department mainly have HFpEF&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">The average of three comorbidities per patient shows the complexity of this population and is in agreement with data on older people with HF in the USA&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> Of note&#44; the prevalences of the two commonest comorbidities&#44; hypertension and diabetes&#44; in our study were similar to that report&#59; this is not the case for AF&#44; which was twice as common in the present study&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> Patients with more than three comorbidities have a higher risk of death and HF hospitalization&#44; as shown by van Deursen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> although in their study only non-cardiovascular comorbidities were analyzed&#46; Another study&#44; on incident HF&#44; reported that patients with HFpEF were more likely to have both cardiac and non-cardiac comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">AF and a history of hypertension were more prevalent in this study population than in others in which HFrEF was more prevalent than HFpEF and patients were enrolled in cardiology wards&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2&#44;4</span></a> This is consistent with the literature on HFpEF populations and with data on Portuguese HF patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;19&#44;25</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Hypertension was the main etiology for HF&#44; according to its prevalence in this population&#44; but the retrospective nature of the study and the non-invasive diagnostic methods used for determining HF etiology prevent further analysis&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">An ischemic etiology was less prevalent &#40;34&#46;6&#37;&#41; than reported by the above-cited European observational trials&#44; which included mostly HFrEF patients &#40;42&#37;-50&#46;7&#37;&#41;&#44; as expected&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;3&#44;4&#44;13</span></a> It is known that patients with HFpEF are less likely to have coronary heart disease and more likely to have hypertension and AF than those with HFrEF&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;6</span></a> We confirmed that ischemic HF patients more often had HFrEF&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">The patient characteristics in this study were similar to those reported by a Spanish heart failure unit in a recent paper from the internal medicine department of a tertiary referral hospital&#44; which describes an elderly population with a mean age of 80&#46;3 years&#44; of whom 54&#46;8&#37; were female&#44; 72&#46;2&#37; had HFpEF &#40;&#8805;50&#37; according to the criteria of this study&#41; and the main etiologies were ischemic and hypertensive in the HFpEF group and ischemic in the HFrEF group&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Infection was the most frequent trigger of HF decompensation in our study&#44; as has been found in other Portuguese and European surveys&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">7&#44;13&#44;25</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">In addition to the significant correlation between sleep apnea&#47;hypoventilation syndrome and treatment by NIV during hospitalization&#44; it is noteworthy that the numbers of patients undergoing NIV with and without one of these diagnoses were similar&#46; This probably means that relieving acute pulmonary congestion and improving pulmonary gas exchange were the main treatment goals in a large number of those treated with NIV&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Our in-hospital mortality was double &#40;7&#46;9&#37;&#41; that reported in a large European observational survey &#40;3&#46;8&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a> and in a US registry &#40;4&#46;0&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> but similar to that reported in other Portuguese studies and in Italian and French surveys &#40;7&#46;7&#37;&#44; 6&#46;9&#37; and 8&#46;2&#37;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;13&#44;25</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">Pharmacological treatment at discharge should be considered in the light of the prevalence of HFpEF in this population&#46; Bearing in mind that no drug therapy has been proved to change prognosis in the HFpEF phenotype&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;16</span></a> it is interesting to see that half of the patients were prescribed beta-blockers or ACE inhibitors&#46; This proportion is similar to that reported in the OFICA study in the HFpEF subgroup&#44; in which 44&#46;2&#37; and 47&#46;3&#37; of this group of patients were discharged under ACE inhibitors and beta-blockers&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> This reflects the use of these drug classes in HFpEF patients with the aim of controlling blood pressure and ventricular rate in AF and decreasing hospitalizations&#46; Ceia et al&#46; found that therapy with ACE inhibitors in Portuguese chronic HF patients was also similar between patients with HFpEF and HFrEF&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">Our finding that beta-blockers and spironolactone were more often prescribed for HFrEF patients shows adherence to current guidelines and their incorporation into clinical practice&#46; The rate of such prescription is similar to that in a European survey for beta-blockers &#40;75&#46;2&#37; vs&#46; 80&#37;&#41; but lower for aldosterone blockers &#40;31&#46;2&#37; vs&#46; 52&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">The total one-year mortality was higher than that reported from the same European region &#40;34&#46;3&#37; vs&#46; 24&#46;7&#37;&#41; by Maggioni et al&#46; in the ESC-HF Pilot survey for the period 2009-2010 and in an Italian survey &#40;24&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2&#44;4</span></a> Cardiovascular causes accounted for half of deaths&#44; a smaller proportion than reported in other observational trials&#44; probably because the type of HF patients hospitalized in cardiology departments are more liable to die of cardiovascular causes&#44; while those hospitalized in internal medicine wards are equally likely to die of other causes&#46; In this respect&#44; it is noteworthy that the patients in our study were 10 years older and had a higher prevalence of comorbidities&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4</span></a> Comorbidity was found to be one of the prime determinants of prognosis in a study of patients hospitalized with HF<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> and HFpEF patients have a higher likelihood of non-cardiovascular death&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> supporting our findings&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">It should be noted that&#44; although it is commonly accepted that the lower the EF the worse the survival&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> in our predominantly HFpEF population neither mortality nor rehospitalization rates were lower&#46; This is in agreement with other hospital-based studies of patients hospitalized with HF that reported similar one-year mortality rates in patients with HFpEF compared to those with HFrEF&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;6</span></a> but not with the OFICA study&#44; which reported higher mortality in the HFrEF population&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">The rehospitalization rate for HF in the first year of follow-up was similar in this study to that found for the same European region in the previously mentioned survey &#40;30&#46;5&#37; vs&#46; 33&#46;9&#37;&#44; respectively&#41;&#46; Of note&#44; the highest rates of mortality and rehospitalization for HF were observed in this region&#44; in comparison with three other European regions&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4</span></a> Bearing in mind the differences in prevalence of HFpEF&#44; this is in agreement with studies reporting that HFpEF patients are as likely to be rehospitalized as HFrEF patients&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">The median time between discharge and first follow-up appointment was much longer than the recommended 7-14 days&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> a situation that we expect to change drastically with the implementation of our heart failure clinic&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">To our knowledge this is the largest Portuguese observational study of patients hospitalized for HF&#44; and the most recent&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Our findings should be considered in the context of several limitations&#46; This was a retrospective registry and did not include all patients hospitalized for HF&#44; including those admitted to the cardiology department of our hospital&#46; Unmeasured variables may have been present that could have influenced the findings&#46; Chronic renal dysfunction was not included in the comorbidities because of the difficulty of ascertaining the chronicity of renal dysfunction in some patients with cardiorenal syndromes&#46; Rehospitalizations were considered only at the study center&#44; and thus may have been underestimated&#46; We did not examine the use of cardiac devices&#44; although there is unlikely to be a significant number of patients with such devices&#44; given the low prevalence of reduced ejection fraction and the old age of this population&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclusions</span><p id="par0290" class="elsevierStylePara elsevierViewall">This is one of the few published observational studies showing the situation in Portugal in terms of HF hospitalization and outcomes&#46; We characterized a large group of patients admitted to an internal medicine department with acute HF&#58; elderly&#44; mostly female&#44; with hypertension and HFpEF&#46; Diabetic patients and those with ischemic heart disease were significantly more likely to have HFrEF&#46; At discharge&#44; more than half of patients were prescribed beta-blockers and ACE inhibitors&#47;ARBs&#44; and those with HFrEF were significantly more often prescribed beta-blockers and spironolactone&#46; Nearly a third of patients died and&#47;or were rehospitalized in the following year&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">Multicenter observational studies in the Portuguese HF population are an unmet need&#46; For the time being&#44; the data presented here will be helpful to measure the impact of the heart failure clinic at our institution in important areas&#44; particularly mortality and rehospitalization outcomes&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Ethical disclosures</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Protection of human and animal subjects</span><p id="par0300" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Confidentiality of data</span><p id="par0305" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Right to privacy and informed consent</span><p id="par0310" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Conflicts of interest</span><p id="par0315" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Patients and comorbidities"
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              "titulo" => "Heart failure"
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              "titulo" => "Relation between ejection fraction and other clinical characteristics"
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              "titulo" => "Follow-up outcomes"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2016-05-10"
    "fechaAceptado" => "2016-10-11"
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            0 => "Heart failure"
            1 => "Mortality"
            2 => "Hospitalization"
            3 => "Patient rehospitalization"
            4 => "Hospital readmission"
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          "palabras" => array:5 [
            0 => "Insufici&#234;ncia card&#237;aca"
            1 => "Mortalidade"
            2 => "Hospitaliza&#231;&#227;o"
            3 => "Reinternamento"
            4 => "Rehospitaliza&#231;&#227;o"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aims to characterize patients hospitalized for acute heart failure &#40;HF&#41; in an internal medicine department and their one-year mortality and rate of rehospitalization for decompensated HF&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This retrospective observational study enrolled all patients discharged in 2012 after hospitalization for acute HF&#46; Discharge summaries&#44; clinical records and telephone interviews were analysed&#46; The data reports to the year before implementation of a heart failure clinic&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Four hundred and twenty-nine patients were enrolled&#44; with a mean age of 79 years&#44; 62&#46;5&#37; female&#46; The most prevalent comorbidity and etiology was hypertension &#40;86&#46;7&#37;&#41; and the most frequent decompensation trigger was infection&#46; HF with preserved ejection fraction &#40;HFpEF&#41; was present in 70&#46;5&#37;&#46; In-hospital mortality was 7&#46;9&#37;&#46; At discharge more than half of the patients were prescribed beta-blockers &#40;52&#46;8&#37;&#41; and angiotensin-converting enzyme inhibitors &#40;52&#37;&#41;&#46; Women presented a significantly higher proportion of HFpEF than men &#40;75&#46;3&#37; vs&#46; 62&#46;7&#37;&#44; p&#61;0&#46;01&#41;&#46; Patients with diabetes and those with ischemic etiology had significantly higher proportions of HF with reduced ejection fraction &#40;HFrEF&#41; &#40;34&#46;8&#37; vs&#46; 24&#46;3&#37; in non-diabetic patients&#44; p&#61;0&#46;027&#44; and 56&#46;2&#37; vs&#46; 15&#46;6&#37; for other etiologies&#44; p&#60;0&#46;001&#41;&#46; The HFrEF group were more frequently discharged under beta-blockers and spironolactone &#40;75&#46;2&#37; vs&#46; 46&#46;4&#37; in the HFpEF group&#44; p&#60;0&#46;001 and 31&#46;2&#37; vs&#46; 12&#46;6&#37; in the HFpEF group&#44; p&#60;0&#46;001&#44; respectively&#41;&#46; Mortality was 34&#46;3&#37; and rehospitalization for HF was 30&#46;5&#37; in one-year follow-up&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The population characterized is an elderly one&#44; mainly female and with HFpEF&#46; Nearly a third of patients died and&#47;or were rehospitalized in the year following discharge&#46;</p></span>"
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          0 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Caracterizar os doentes hospitalizados por Insufici&#234;ncia Card&#237;aca &#40;IC&#41; aguda num Servi&#231;o de Medicina Interna&#44; a mortalidade e rehospitaliza&#231;&#227;o por IC no primeiro ano&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo retrospetivo observacional incluindo todos os doentes com alta em 2012 de hospitaliza&#231;&#227;o por IC aguda&#44; com base em Notas de Alta&#44; registos cl&#237;nicos e entrevistas telef&#243;nicas&#46; Reporta-se ao ano pr&#233;vio &#224; implementa&#231;&#227;o de uma cl&#237;nica de IC&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Identificaram-se 429 doentes&#44; com idade m&#233;dia de 79 anos&#59; 62&#44;5&#37; eram mulheres&#46; A comorbilidade e etiologia mais prevalente foi a hipertens&#227;o arterial &#40;86&#44;7&#37;&#41; e o fator precipitante mais frequente da descompensa&#231;&#227;o foi a infe&#231;&#227;o&#46; Verificou-se Fra&#231;&#227;o de Eje&#231;&#227;o Preservada &#40;FEp&#41; em 70&#44;5&#37; dos doentes&#46; A mortalidade intra-hospitalar foi 7&#44;9&#37;&#46; &#192; alta&#44; a maioria dos doentes tinha prescri&#231;&#227;o de betabloqueadores &#40;BB&#41; &#40;52&#44;8&#37;&#41; e inibidores de enzima de convers&#227;o da angiotensina &#40;52&#37;&#41;&#46; As mulheres apresentaram mais frequentemente FEp do que os homens &#40;75&#44;3&#37; <span class="elsevierStyleItalic">versus</span> 62&#44;7&#37;&#44; p&#61;0&#44;01&#41;&#46; Os doentes diab&#233;ticos e os com etiologia isqu&#233;mica apresentaram mais frequentemente Fra&#231;&#227;o de Eje&#231;&#227;o Reduzida &#40;FEr&#41; &#40;34&#44;8&#37; <span class="elsevierStyleItalic">versus</span> 24&#44;3&#37; em n&#227;o diab&#233;ticos&#44; p&#61;0&#44;027 e 56&#44;2&#37; <span class="elsevierStyleItalic">versus</span> 15&#44;6&#37; com outras etiologias&#44; p&#60;0&#44;001&#44; respetivamente&#41;&#46; No grupo com FEr&#44; os BB e a espironolactona foram mais prescritos &#224; alta &#40;75&#44;2&#37; <span class="elsevierStyleItalic">versus</span> 46&#44;4&#37; no grupo com FEp&#44; p&#60;0&#44;001 e 31&#44;2&#37; <span class="elsevierStyleItalic">versus</span> 12&#44;6&#37; no grupo com FEp&#44; p&#60;0&#44;001&#44; respetivamente&#41;&#46; No primeiro ano&#44; a taxa de mortalidade foi 34&#44;3&#37; e de rehospitaliza&#231;&#227;o por IC 30&#44;5&#37;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A popula&#231;&#227;o estudada &#233; idosa&#44; predominantemente feminina e apresenta IC com FEp&#46; Um ter&#231;o morreu e&#47;ou foi reinternada no ano seguinte&#46;</p></span>"
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        "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0065">List of abbreviations</span>"
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            "definicion" => array:10 [
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                "termino" => "ACE"
                "descripcion" => "<p id="par0005" class="elsevierStylePara elsevierViewall">angiotensin-converting enzyme</p>"
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              1 => array:2 [
                "termino" => "AF"
                "descripcion" => "<p id="par0010" class="elsevierStylePara elsevierViewall">atrial fibrillation</p>"
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              2 => array:2 [
                "termino" => "ARB"
                "descripcion" => "<p id="par0015" class="elsevierStylePara elsevierViewall">angiotensin receptor blocker</p>"
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              3 => array:2 [
                "termino" => "EF"
                "descripcion" => "<p id="par0020" class="elsevierStylePara elsevierViewall">ejection fraction</p>"
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                "termino" => "HF"
                "descripcion" => "<p id="par0025" class="elsevierStylePara elsevierViewall">heart failure</p>"
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                "termino" => "HFpEF"
                "descripcion" => "<p id="par0030" class="elsevierStylePara elsevierViewall">heart failure with preserved ejection fraction</p>"
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                "termino" => "HFrEF"
                "descripcion" => "<p id="par0035" class="elsevierStylePara elsevierViewall">heart failure with reduced ejection fraction</p>"
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              7 => array:2 [
                "termino" => "ICD-9"
                "descripcion" => "<p id="par0040" class="elsevierStylePara elsevierViewall">International Classification of Diseases&#44; 9th Revision</p>"
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                "termino" => "NIV"
                "descripcion" => "<p id="par0045" class="elsevierStylePara elsevierViewall">non-invasive ventilation</p>"
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                "termino" => "NT-proBNP"
                "descripcion" => "<p id="par0050" class="elsevierStylePara elsevierViewall">N-terminal-pro-B type natriuretic peptide</p>"
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        "etiqueta" => "Figure 1"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow diagram of patient enrollment&#46; The data refer to admissions to the internal medicine department in the study period&#46; HF&#58; heart failure&#59; ICD-9&#58; International Classification of Diseases&#44; 9th Revision&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&#44; mean &#177; SD&#59; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#177;10&#59; 81 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic etiology&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">402&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission SBP &#40;mmHg&#41;&#44; mean &#177; SD&#59; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">139&#46;5&#177;29&#46;2&#59; 136 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">420&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ejection fraction &#62;40&#37;&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AF&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cerebrovascular disease&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peripheral arterial disease&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic pulmonary disease&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Active cancer&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sleep apnea&#47;hypoventilation syndrome&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dementia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#62;3 comorbidities&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Physically active&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HF decompensation trigger&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infection&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Non-adherence to treatment&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rhythm disturbances&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anemia&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plasma creatinine &#62;1&#46;5 &#40;mg&#47;dl&#41; &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">428&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission plasma creatinine &#40;mg&#47;dl&#41;&#44; mean &#177; SD&#59; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;3&#177;0&#46;6&#59; 1&#46;2 &#40;0&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">428&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission sodium &#40;mmol&#47;l&#41;&#44; mean &#177; SD&#59; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">136&#46;4&#177;5&#46;7&#59; 137 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">428&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin &#40;g&#47;dl&#41;&#44; mean &#177; SD&#59; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#177;2&#46;1&#59; 12 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">First NT-proBNP &#40;pg&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6698&#177;10848&#59; 2697 &#40;6105&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">366&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ACE&#58; angiotensin-converting enzyme&#59; ARB&#58; angiotensin receptor blocker&#59; HFpEF&#58; heart failure with preserved ejection fraction&#59; HFrEF&#58; heart failure with reduced ejection fraction&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Values refer to percentage of patients discharged in each group&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients<br><span class="elsevierStyleItalic">Drug</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HFrEF<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Beta-blocker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACE inhibitor&#47;ARB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;237&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Spironolactone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anticoagulant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Medications prescribed at discharge for the 394 patients discharged alive&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;439&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;80 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;80 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Ischemic etiology</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hypertension</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;216&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">AF</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;704&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cerebrovascular disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;637&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">PAD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chronic pulmonary disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;189&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Active cancer</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;522&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sleep apnea&#47;hypoventilation syndrome</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Dementia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;782&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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        "texto" => "<p id="par0320" class="elsevierStylePara elsevierViewall">The authors wish to thank Jo&#227;o Pedro Ferreira for his contribution to the design and data collection for this study and In&#234;s Silveira for data collection&#46;</p> <p id="par0325" class="elsevierStylePara elsevierViewall">Novartis Pharma supported the statistical analysis through an unrestricted grant&#46;</p> <p id="par0330" class="elsevierStylePara elsevierViewall">Bet&#226;nia Ferreira is currently an employee of Hospital da Luz Arr&#225;bida&#44; Grupo Luz Sa&#250;de&#44; Vila Nova de Gaia&#44; Portugal&#46; Sandra Nunes is currently an employee of Centro Hospitalar Entre Douro e Vouga&#44; E&#46;P&#46;E&#44; Santa Maria da Feira&#44; Portugal&#46;</p>"
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