{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T04:10:00Z","timestamp":1784607000965,"version":"3.55.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T00:00:00Z","timestamp":1596240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T00:00:00Z","timestamp":1596240000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The coexistence of other comorbidities confers poor outcomes in patients with acute heart failure. Our aim was to determine the characteristics of patients with acute heart failure and cardiorenal anaemia syndrome and the relationship between renal dysfunction and anaemia, alone or combined as cardiorenal anaemia syndrome, on short-term outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analysed the Epidemiology of Acute Heart Failure in Emergency Departments registry (cohort of patients with acute heart failure in Spanish emergency departments). Renal dysfunction was defined by an estimated glomerular filtration rate &amp;lt;60 ml\/min\/m2, anaemia by haemoglobin values &amp;lt;12\/&amp;lt;13 g\/dl in women\/men, and cardiorenal anaemia syndrome as the presence of both. Comparisons were made according to cardiorenal-anaemia syndrome positive (CRAS+) with respect to the rest of patients (CRAS\u2013) and according the presence of renal dysfunction (RD+) and anaemia (A+), (alone, RD+\/A\u2013, RD\u2013\/A+) or in combination (RD+\/A+; i.e. CRAS+) with respect to patients without renal dysfunction and anaemia (RD\u2013\/A\u2013). The primary outcome was 30-day mortality, and the secondary outcomes were need for admission, prolonged hospitalisation (&amp;gt;10 days), in-hospital mortality during the index event, and reconsultation and the combination of 30-day post-discharge reconsultation\/death. These short-term outcomes were compared and adjusted for differences among groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 13,307 patients analysed, CRAS+ (36.4%) was associated with older age, multiple comorbidities, chronic use of loop diuretics, oedemas and hypotension. The 30-day mortality in CRAS+ was greater than in CRAS\u2013 (hazard ratio\u2009=\u20091.46, 95% confidence interval\u2009=\u20091.26\u20131.68) and RD\u2013\/A\u2013 (hazard ratio\u2009=\u20091.83, 95% confidence interval\u2009=\u20091.46\u20132.28) control groups. The mortality level was also higher in RD+\/A\u2013 (hazard ratio\u2009=\u20091.40, 95% confidence interval\u2009=\u20091.10\u20131.78) and higher, but not statistically significant, in RD\u2013\/A+ (hazard ratio\u2009=\u20091.28, 95% confidence interval\u2009=\u20090.99\u20131.63) with respect to RD\u2013\/A\u2013. All of the secondary outcomes, when related to CRAS\u2013 and RD\u2013\/A\u2013 control groups, were worse for CRAS+ and to a lesser extent, RD+\/A\u2013, being more rarely observed in RD\u2013\/A+.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Cardiorenal anaemia syndrome in acute heart failure is related to greater mortality and worse short-term outcomes, and the impact of renal dysfunction and anaemia seems to be additive.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1177\/2048872620921602","type":"journal-article","created":{"date-parts":[[2020,5,14]],"date-time":"2020-05-14T08:19:17Z","timestamp":1589444357000},"page":"406-418","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["The CRAS-EAHFE study: Characteristics and prognosis of acute heart failure episodes with cardiorenal-anaemia syndrome at the emergency department"],"prefix":"10.1093","volume":"9","author":[{"given":"Lluis","family":"Llauger","sequence":"first","affiliation":[{"name":"Emergency Department, Hospital Universitari de Vic, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Jacob","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitari de Bellvitge, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Herrero-Puente","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Central de Asturias, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfons","family":"Aguirre","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital del Mar, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillem","family":"Su\u00f1\u00e9n-Cuquerella","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital del Mar, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard","family":"Corominas-Lasalle","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitari de Vic, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pere","family":"Llorens","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital General de Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco J","family":"Mart\u00edn-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Emergency Department, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00edctor","family":"Gil","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Cl\u00ednic, University of Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Roset","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitari de Bellvitge, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 C","family":"Ruibal","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitari de Bellvitge, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda J","family":"P\u00e9rez-Dur\u00e1","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitario La Fe, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda \u00c1","family":"Juan-G\u00f3mez","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Doctor Peset, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 M","family":"Garrido","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Virgen de la Macarena, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Richard","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitario de Burgos, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco J","family":"Lucas-Imbernon","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital General Universitario de Albacete, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00e9ctor","family":"Alonso","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Marqu\u00e9s de Valdecilla, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep","family":"Tost","sequence":"additional","affiliation":[{"name":"Emergency Department, Consorci Hospitalari de Terrassa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Gil","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitario de Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d2scar","family":"Mir\u00f3","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Cl\u00ednic, University of Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,8,1]]},"reference":[{"key":"2021020117061690200_bibr1-2048872620921602","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.recesp.2013.03.014","article-title":"Epidemiology of heart failure in Spain over the last 20 years.","volume":"66","author":"Sayago-Silva","year":"2013","journal-title":"Rev Esp Cardiol (Engl 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Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur Heart J"},{"key":"2021020117061690200_bibr4-2048872620921602","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s00392-018-1261-z","article-title":"Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure.","volume":"107","author":"Llorens","year":"2018","journal-title":"Clin Res Cardiol"},{"key":"2021020117061690200_bibr5-2048872620921602","doi-asserted-by":"crossref","first-page":"698","DOI":"10.7326\/M16-2726","article-title":"Predicting 30-day mortality for patients with acute heart failure in the emergency department: A cohort study","volume":"167","author":"Mir\u00f3","year":"2017","journal-title":"Ann Intern Med"},{"key":"2021020117061690200_bibr6-2048872620921602","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.medcli.2018.05.010","article-title":"Renal function and acute heart failure outcome.","volume":"151","author":"Llauger","year":"2018","journal-title":"Med Clin (Barc)"},{"key":"2021020117061690200_bibr7-2048872620921602","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.recesp.2014.02.023","article-title":"Economic impact of heart failure according to the effects of kidney failure","volume":"68","author":"Sicras Mainar","year":"2015","journal-title":"Rev Esp Cardiol"},{"key":"2021020117061690200_bibr8-2048872620921602","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/ejhf.1369","article-title":"The use of diuretics in heart failure with congestion \u2013 a position statement from the Heart Failure Association of the European Society of Cardiology.","volume":"21","author":"Mullens","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2021020117061690200_bibr9-2048872620921602","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1002\/ejhf.1502","article-title":"Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes.","volume":"21","author":"Javaloyes","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2021020117061690200_bibr10-2048872620921602","first-page":"318","article-title":"Prognostic value of chest radiographs in patients with acute heart failure: The Radiology in Acute Heart Failure (RAD-ICA) study","volume":"31","author":"Llorens","year":"2019","journal-title":"Emergencias"},{"key":"2021020117061690200_bibr11-2048872620921602","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.amjcard.2015.01.019","article-title":"Interaction between worsening renal function and persistent congestion in acute decompensated heart failure","volume":"115","author":"Wattad","year":"2015","journal-title":"Am J Cardiol"},{"key":"2021020117061690200_bibr12-2048872620921602","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.ejim.2019.07.010","article-title":"ICASEMES-Research Group. Acute heart failure and adverse events associated with the presence of renal dysfunction and hyperkalaemia","volume":"67","author":"Jacob","year":"2019","journal-title":"Eur J Intern Med"},{"key":"2021020117061690200_bibr13-2048872620921602","article-title":"Hyperkalemia in heart failure patients in Spain and its impact on guidelines and recommendations: ESC-EORP-HFA Heart Failure Long-Term Registry","author":"Crespo-Leiro","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"key":"2021020117061690200_bibr14-2048872620921602","doi-asserted-by":"crossref","first-page":"viii7","DOI":"10.1093\/ndt\/gfg1084","article-title":"The cardio-renal anaemia syndrome: Does it exist?","volume":"18","author":"Silverberg","year":"2003","journal-title":"Nephrol Dial Transplant"},{"key":"2021020117061690200_bibr15-2048872620921602","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.amjcard.2006.01.107","article-title":"Anemia, renal dysfunction, and their interaction in patients with chronic heart failure","volume":"98","author":"de Silva","year":"2006","journal-title":"Am J Cardiol"},{"key":"2021020117061690200_bibr16-2048872620921602","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.amjcard.2012.12.049","article-title":"Cardiorenal anemia syndrome as a prognosticator for death in heart failure","volume":"111","author":"Lu","year":"2013","journal-title":"Am J Cardiol"},{"key":"2021020117061690200_bibr17-2048872620921602","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/eurjhf\/hfq167","article-title":"The cardio-renal anemia syndrome in systolic heart failure: Prevalence, clinical correlates, and long-term survival","volume":"13","author":"Scrutinio","year":"2011","journal-title":"Eur J Heart Fail"},{"key":"2021020117061690200_bibr18-2048872620921602","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12872-017-0497-2","article-title":"Cardiorenal anemia syndrome and survival among heart failure patients in Tanzania: A prospective cohort study","volume":"17","author":"Pallangyo","year":"2017","journal-title":"BMC Cardiovascular Disord"},{"key":"2021020117061690200_bibr19-2048872620921602","first-page":"100415","article-title":"CN-HF investigators. Outcomes of patients with anemia and renal dysfunction in hospitalized heart failure with preserved ejection fraction (from the CN-HF registry)","volume":"25","author":"Jin","year":"2019","journal-title":"Int J Cardiol Heart Vasc"},{"key":"2021020117061690200_bibr20-2048872620921602","doi-asserted-by":"crossref","first-page":"1912","DOI":"10.2215\/CJN.04400514","article-title":"Associations of anemia and renal dysfunction with outcomes among patients hospitalized for acute decompensated heart failure with preserved or reduced ejection fraction","volume":"9","author":"Kajimoto","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"2021020117061690200_bibr21-2048872620921602","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1177\/2048872615593387","article-title":"Association of anemia and renal dysfunction with in-hospital mortality among patients hospitalized for acute heart failure syndromes with preserved or reduced ejection fraction.","volume":"5","author":"Kajimoto","year":"2016","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2021020117061690200_bibr22-2048872620921602","doi-asserted-by":"crossref","first-page":"e0201714","DOI":"10.1371\/journal.pone.0201714","article-title":"Renal function and anemia in relation to short- and long-term prognosis of patients with acute heart failure in the period 1985-2008: A clinical cohort study.","volume":"13","author":"van den Berge","year":"2018","journal-title":"PLoS One"},{"key":"2021020117061690200_bibr23-2048872620921602","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4757-3462-1","volume-title":"Regression modeling strategies: With applications to linear models, logistic regression, and survival analysis","author":"Harrell","year":"2001"},{"key":"2021020117061690200_bibr24-2048872620921602","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1002\/ehf2.12351","article-title":"Incidence and impact of cardiorenal anaemia syndrome on all-cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East","volume":"6","author":"Al-Jarallah","year":"2019","journal-title":"ESC Heart Fail"},{"key":"2021020117061690200_bibr25-2048872620921602","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1016\/j.jacc.2008.04.061","article-title":"Anemia and mortality in heart failure patients a systematic review and meta-analysis","volume":"52","author":"Groenveld","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"2021020117061690200_bibr26-2048872620921602","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1161\/01.CIR.0000134279.79571.73","article-title":"Anemia and its relationship to clinical outcome in heart failure","volume":"110","author":"Anand","year":"2004","journal-title":"Circulation"},{"key":"2021020117061690200_bibr27-2048872620921602","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.amjcard.2007.07.067","article-title":"Relation of low hemoglobin and anemia to morbidity and mortality in patients hospitalized with heart failure (insight from the OPTIMIZE-HF registry)","volume":"101","author":"Young","year":"2008","journal-title":"Am J Cardiol"},{"key":"2021020117061690200_bibr28-2048872620921602","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1161\/CIRCHEARTFAILURE.111.963413","article-title":"Is worsening renal function an ominous prognostic sign in patients with acute heart failure? The role of congestion and its interaction with renal function.","volume":"5","author":"Metra","year":"2012","journal-title":"Circ Heart Fail"},{"key":"2021020117061690200_bibr29-2048872620921602","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1161\/01.CIR.0000052623.16194.80","article-title":"Hemodilution is common in patients with advanced heart failure","volume":"107","author":"Androne","year":"2003","journal-title":"Circulation"},{"key":"2021020117061690200_bibr30-2048872620921602","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1536\/ihj.17-307","article-title":"Hemodilution after initial treatment in patients with acute decompensated heart failure","volume":"59","author":"Fujita","year":"2018","journal-title":"Int Heart J"},{"key":"2021020117061690200_bibr31-2048872620921602","first-page":"27","article-title":"Planning to reduce 30-day adverse events after discharge of frail elderly patients with acute heart failure: Design and rationale for the DEED FRAIL-AHF trial","volume":"31","author":"Mart\u00edn-S\u00e1nchez","year":"2019","journal-title":"Emergencias"},{"key":"2021020117061690200_bibr32-2048872620921602","first-page":"5","article-title":"Patients with acute heart failure discharged from the emergency department and classified as low risk by the MESSI score (multiple risk estimate based on the Spanish emergency department scale): Prevalence of adverse events and predictability)","volume":"31","author":"Mir\u00f3","year":"2019","journal-title":"Emergencias"},{"key":"2021020117061690200_bibr33-2048872620921602","first-page":"3","article-title":"Is the MEESSI-AHF score for Multiple Estimation of risk based on the Spanish Emergency department Score in patients with Acute Heart Failure an effective basis for discharging patients with","volume":"31","author":"Masip","year":"2019","journal-title":"Emergencias"},{"key":"2021020117061690200_bibr34-2048872620921602","first-page":"413","article-title":"Physical frailty and its impact 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