Clinical predictors of in-hospital mortality in patients admitted with acute heart failure in an intensive care department

Abstract

Listen

Translate article

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure (HF) is one of the major contemporary clinical challenges. Its prognosis is worse in the presence of exacerbations that require intensive care. Data regarding predictors of short-term prognosis of critical acute heart failure (AHF) in the contemporary era is lacking. Aims To identify independent clinical predictors of in-hospital mortality in this subgroup of patients. Methods Retrospective study of patients admitted at an ICU with the diagnosis of AHF between January and December of 2019 in a tertiary care hospital. Multivariable logistic regression analysis corrected for age, co-morbidities, clinical presentation severity and therapeutic measures was performed for in-hospital mortality. Results 239 patients were included, predominantly men (60.7%), with a mean age of 69.5±14.8 years old. A high burden of cardiovascular risk factors was present and the majority didn’t have a previous known HF diagnosis (59.9%). Ischaemic disease was the most prevalent underlying cause (27.6%) and acute coronary syndrome was the most common trigger (35.6%). Mean ejection fraction was 37.5±16.9%. Mechanical circulatory support (MCS) was needed in 9.6% of the patients. Mean length of hospitalization was 5.6±6.0 days and in-hospital mortality rate was 18.9% (n=44). Cardiogenic shock unresponsive to the therapeutic measures (54.5%) and septic shock (20.5%) were the main causes of death. In-hospital mortality was higher in male patients (75.0% vs. 25.0%; p=0.03), who presented with sudden cardiac arrest (SCA) and cardiogenic shock (p<0.001); who required MCS (p<0.001) and evolved with a nosocomial infection (p=0.006); it was positively correlated with SAPS II score (p<0.001) and negatively correlated with LVEF (p=0.002). In a multivariable logistic regression analysis MCS, older age and SCA at presentation were the only parameters with significant correlation with this outcome. Conclusions In the face of the need to manage limited resources, aspect that acquires more relevance in an intensive care scenario, identification of mortality predictors in critical AHF is relevant in order to develop risk scoring systems that allow to adequately select patients with a higher probability of survival. In our registry, age and severity of clinical presentation in terms of hemodynamic impact were the most robust variables to predict in-hospital mortality, more than previous known co-morbidities. Specifically, it draws attention to the need of careful analysis in larger studies of the subgroup of patients with SCA at admission to identify those in which intensive care measures will be superfluous to apply. It also highlights the relevance of taking measures to prevent nosocomial infection that assumes an important role in the mortality of these patients.