Outcomes and predictors of one-year mortality in patients hospitalized with Acute Heart Failure

Highlights

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  Patients hospitalized with acute heart failure had very high mortality with the majority of death happened after discharge.

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  Independent prognostic predictors for 1-year mortality after acute heart failure hospitalization were elderly, history of cerebrovascular accident and NT-proBNP ≥10,000 pg/ml.

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  Patient who had heart failure reduced ejection fraction had lower mortality than preserved ejection fraction.

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  Patients with hypertension showed better survival at 1 year after acute heart failure hospitalization.

Abstract

Background

Registries of patients hospitalized with acute heart failure (AHF) provided useful description of characteristics and outcomes. However, a contemporary registry which provides sufficient evidence on outcomes after discharge is needed.

Objective

The study aims to identify 1-year clinical outcomes and prognostic predictors of patients hospitalized with AHF.

Method

This is a retrospective registry which enrolled patients who were hospitalized due to a principal diagnosis of AHF in a tertiary care center in Thailand between July 2017 and June 2019. Baseline characteristics and hospital courses between the deceased patients and the survivors at 1 year were compared. Prognostic predictors for 1-year mortality were analyzed using Cox regression model.

Results

A total of 759 patients were enrolled (mean age of 68.9 ± 15 years, 49.8% men, mean ejection fraction of 47.1 ± 19.2%, 55.7% heart failure reduced ejection fraction (HFrEF)). Among these, 40.7% had no history of heart failure. The in-hospital and 1-year mortality was 5.8% and 21.5%, respectively. Patients with HFrEF had lower 1-year mortality compared to those without (HR = 0.57, p = 0.04). Age ≥ 70 years, the history of heart failure, prior heart failure hospitalization, cerebrovascular accident (CVA), reactive airway disease, cancer, length of stay > 10 days and NT-proBNP ≥ 10,000 pg/mL were associated with higher 1-year mortality (p < 0.05). The multivariate analysis showed age, CVA and NT-proBNP were independent predictors.

Conclusion

Patients with AHF had high mortality after discharge. Patients with poor prognostic predictors, such as elderly, may benefit from continuous care. The study is the most recent registry of patients with AHF in Thailand.