Introduction: Most knowledge about the main causes of heart failure decompensation come from hospital setting. However, evidence coming from primary care is scarce.

Hypothesis: It is possible to identify the main causes of decompensation of HF in order to prevent and treat them

Methods: HEFESTOS is a multinational collaborative cohort study carried out in 10 European countries, aimed at knowing the main precipitant factors related to a heart failure decompensation, attended in primary care setting and its relationship to the prognosis at short term. Patients were consecutively recruited and followed for one month after the decompensation

Results: 685 patients were prospectively included. Women represented 54.5% and mean age was 81.2 (DE 8.90) years. Potential causative factors for decompensated heart failure were identified in 77.9 % of cases. More than one factor was identified in 35.9% of patients. Respiratory infections, Non-compliance with fluid or salt restriction, non-medication adherence, and atrial fibrillation, were the most commonly identified factors (28.2%, 26.8%, 22.8% and 14.5%, respectively). A total of 28.2% of patients were hospitalized and 3.5% died. After adjusting for potential confounding factors, only respiratory infections and atrial fibrillation were significantly associated with hospitalization or mortality (OR 1.19, 95%CI 1.09-1.19 and 1.22, 95%CI, 1.10-1.35), respectively

Conclusions: An early identification and treatment of respiratory infection and atrial fibrillation would help to prevent hospitalizations and mortality in heart failure patients presenting heart failure decompensation.