Characteristics and outcomes of patients admitted for acute heart failure in a single-centre study

Abstract

Aims: Acute heart failure represents a medical condition with very high mortality. Accurate risk stratification can help physicians to improve the health care about these patients. The aim of our study was to characterize real-life patients admitted for acute heart failure in a specific region with one tertiary medical centre and to describe risk factors of short-term and long-term mortality.

Methods and results: We performed a retrospective analysis of patients admitted from January 2017 to December 2017 to Department of cardiology of the tertiary medical centre University Hospital in Hradec Kralove. We identified 385 patients admitted for acute heart failure to the standard care and intensive care unit. The median of age was 74 years (IQR 67.5-80) and 34% of patients were female. Hospital admission was due to de novo heart failure in 222 (57.7%) patients. The most common comorbidities were arterial hypertension (77.7%), dyslipidaemia (67.3%) and coronary artery disease (63.1%). Coronary artery disease (52.7% of cases) and valve disease (28.1% of cases) were the most common aetiologies of heart failure. The all-cause in-hospital mortality was 12.7%, 30-day mortality was 14.6% and 1 year mortality was 34%. Among risk factors of in-hospital mortality, the most significant factors were haemodialysis during the hospitalization [odds ratio (OR) 15.82, 95% confidence interval (CI) 2.96-84.57, P = 0.0008], chronic heart failure (OR 4.27, 95% CI 1.66-11.03, P = 0.001) and STEMI as a precipitating factor of heart failure (OR 4.19, 95% CI 1.23-14.25, P = 0.023). Haemodialysis during the hospitalization (OR 4.28, 95% CI 1.17-15.61, P = 0.025) and the comorbidity depression and anxiety (OR 3.49, 95% CI 1.45-8.39, P = 0.005) were the most significant risk factors of long-term mortality.

Conclusions: Our study confirms very high mortality rates among patients with acute heart failure underlying poor prognosis of these patients. Comorbidities (peripheral artery disease, atrial fibrillation, chronic heart failure and depression and anxiety), precipitating factors of heart failure (myocardial infarction with ST segment elevation), complications occurring during the hospitalization (acute kidney injury, pulmonary ventilation for respiratory failure and haemodialysis) and the age of patients should be included in the risk stratification of in-hospital, 30 day and 1 year mortality.

Keywords: Epidemiology; Heart failure; Mortality; Risk factors.