Acute decompensated heart failure in a North Indian community hospital: Demographics, clinical characteristics, comorbidities and adherence to therapy

Abstract

BackgroundAcute decompensated heart failure (ADHF) is a growing public health problem in the community. Limited and often contradictory data are available from small studies published from India. Objective of this study was to report clinical characteristics, outcome, and discharge treatment strategies of these patients from a single community hospital. MethodsIn this observational prospective study from a multispeciality community hospital from North India, data were collected to include demographics, clinical characteristics, management strategies, and prognosis in 428 patients with ADHF admitted for more than two consecutive years (January 2017 through December 2018). ResultsThe study included 428 patients (mean age 61 ± 14 years) of whom 59% were male. ADHF with reduced left ventricular ejection fraction (HFrEF) was present in 77% subjects; Preserved (≥50%) and midrange ejection fraction (41–49%) with ADHF was observed in 12% and 11% patients, respectively. Ischemic etiology was noticed in 69% of the population. Prior myocardial revascularisation was observed in 47% of all and in 71% of those with ischemic heart disease. Major comorbidities included type 2 diabetes mellitus (60.7%), arterial hypertension (51%), anemia (54%), chronic kidney disease (29%), atrial fibrillation (16%), and hypothyroidism (9%). Mean hospital stay was 4.5 ± 3.2 days (inter-quartile range: 2–9 days). In-hospital mortality was 8.4% (36 patients) and there were additional 17% deaths over 6 months after discharge. At-discharge medication in those with HFrEF included anti–renin–angiotensin agents (57%), beta-adrenergic receptor blocking agents in 53%, mineralocorticoid receptor antagonists in 34%, ivabradine in 21%, and digoxin in 5%. Angiotensin–neprilysin inhibitor was prescribed to 21% patients at discharge. Ferric carboxymaltose use was in 7.5% of all despite a high prevalence of anemia (54%). Vaccination status at discharge was not available in majority. ConclusionThe commonest cause of ADHF presenting to this community hospital was HFrEF of ischemic etiology. It is associated with significant in-hospital mortality. There is substantial under-use of guideline-recommended chronic heart failure therapies at hospital discharge. These data provide useful information which can be used to improve patient care and formulate future strategies for management of ADHF.