{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:14:33Z","timestamp":1760148873104,"version":"build-2065373602"},"reference-count":36,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T00:00:00Z","timestamp":1686614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Torrec\u00e1rdenas University Hospital (Almer\u00eda, Spain)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Among the clinical predictors of a heart failure (HF) prognosis, different personal factors have been established in previous research, mainly age, gender, anemia, renal insufficiency and diabetes, as well as mediators (pulmonary embolism, hypertension, chronic obstructive pulmonary disease (COPD), arrhythmias and dyslipidemia). We do not know the role played by contextual and individual factors in the prediction of in-hospital mortality. Methods: The present study has added hospital and management factors (year, type of hospital, length of stay, number of diagnoses and procedures, and readmissions) in predicting exitus to establish a structural predictive model. The project was approved by the Ethics Committee of the province of Almeria. Results: A total of 529,606 subjects participated, through databases of the Spanish National Health System. A predictive model was constructed using correlation analysis (SPSS 24.0) and structural equation models (SEM) analysis (AMOS 20.0) that met the appropriate statistical values (chi-square, usually fit indices and the root-mean-square error approximation) which met the criteria of statistical significance. Individual factors, such as age, gender and chronic obstructive pulmonary disease, were found to positively predict mortality risk. Isolated contextual factors (hospitals with a greater number of beds, especially, and also the number of procedures performed, which negatively predicted the risk of death. Conclusions: It was, therefore, possible to introduce contextual variables to explain the behavior of mortality in patients with HF. The size or level of large hospital complexes, as well as procedural effort, are key contextual variables in estimating the risk of mortality in HF.<\/jats:p>","DOI":"10.3390\/jpm13060995","type":"journal-article","created":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T02:26:56Z","timestamp":1686709616000},"page":"995","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Structural Model of Biomedical and Contextual Factors Predicting In-Hospital Mortality due to Heart Failure"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0923-5899","authenticated-orcid":false,"given":"Juan Manuel","family":"Garc\u00eda-Torrecillas","sequence":"first","affiliation":[{"name":"Emergency and Research Unit, Torrec\u00e1rdenas University Hospital, 04009 Almer\u00eda, Spain"},{"name":"CIBER de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), 28029 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria Ibs, 18012 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda Carmen","family":"Lea-Pereira","sequence":"additional","affiliation":[{"name":"Hospital de Poniente, El Ejido, 04700 Almer\u00eda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrique","family":"Alonso-Morillejo","sequence":"additional","affiliation":[{"name":"School of Psychology, University of Almer\u00eda, 04120 Almer\u00eda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilio","family":"Moreno-Mill\u00e1n","sequence":"additional","affiliation":[{"name":"Equipo de Investigaci\u00f3n SEJ-581, Departamento de Econom\u00eda Aplicada, Universidad de Almer\u00eda, 04120 Almer\u00eda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1829-9202","authenticated-orcid":false,"given":"Jes\u00fas","family":"de la Fuente-Arias","sequence":"additional","affiliation":[{"name":"School of Education and Psychology, University of Navarra, 31009 Pamplona, Spain"},{"name":"School of Education and Psychology, University of Almer\u00eda, 04120 Almer\u00eda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,13]]},"reference":[{"key":"ref_1","first-page":"31","article-title":"Epidemiology and treatment of heart failure in Spain: The HF-PATHWAYS study","volume":"75","author":"Palacios","year":"2022","journal-title":"Rev. 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