Clinical Profile, Precipitating Factors, and In-Hospital Outcomes of Patients Admitted with Acute Decompensated Heart Failure: A Prospective Observational Study

Background: Acute decompensated heart failure (ADHF) is a major cause of hospitalizations, and mortality and morbidity rates are high. There are limited data on patient characteristics, precipitating factors and the short-term outcomes of Indian populations. The goal of the reseach is to assess clinical profile, heart failure (HF) pheno-type, precipitating factors, and outcome of the in-hospital experience of ADHF patients. Material and Methods: This study is a prospective observational study of 96 consecutive adult patients who were admitted with ADHF in a tertiary care teaching hospital. Framingham criteria were used for diagnosis, and the American Heart Association guidelines for heart failure staging. Clinical data, laboratory measurements, echocardiographic data, precipitating cause and in-hospital results were collected. While p<0.05 was used as indication of significance, suitable parametric and non-parametric statistical tests were used. Results: Of note, the mean LVEF of the study population was 32.98±11.94%, and the most common phenotype was HF with reduced EF (HFrEF, 69.8%). Hypertension (55.2%) and diabetes mellitus (42.7%) were the most common comorbidities. The major etiologies were ischemic cardiomyopathy followed by hypertensive heart disease (30.2%, 26.0%). Infections (29.2%) and acute coronary syndrome (17.7%) were the most common precipitating factors. Sixty-three percent (63.5%) of the patients improved, 19.8% experienced refractory symptoms, and 16.7% passed away while hospitalized. Oxygen saturation and SBP were significantly lower while BNP was significantly higher for non-survivors. There was a strong association between mortality and AHA Stage D heart failure (p<0.001). Conclusion: ADHF has high in-hospital mortality rate, especially if there is advanced heart failure and hemodynamic compromise. HFrEF was the most prevalent phenotype and had worse outcomes. Early risk stratification and urgent appropriate management following the guidelines can lead to better short-term results.

Keywords: Acute decompensated heart failure; In-hospital mortality; B-type natriuretic peptide; Echocardiography; Risk stratification.