Predictors of In-Hospital Events for Patients with Nonischemic Acute Heart Failure

Abstract

Abstract Aim The main purpose of this article is to evaluate the clinical profile and in-hospital outcome among heart failure (HF) patients due to different diseases other than acute coronary syndromes (ACS) admitted in intensive coronary care unit (ICCU) at a tertiary center in South India. Materials and Methods This is an observational study of HF patients who were admitted to ICCU for a period of 6 months from January 2019 to June 2019. ACS patients were excluded. All the demographic data, clinical history, examination details, electrocardiographic (ECG), two-dimensional echocardiography (ECHO), baseline routine, and special investigations were collected. In-hospital progress of the patient was monitored along with events (recurrence of HF, arrhythmias, acute kidney injury, cardiogenic shock, and death). Results The total number of patients included in the study was 130. The male:female ratio was 2.09:1(88/42) with a mean age of 53.61 years. Hypertension and diabetes were present in 52.3% (68 patients). The etiology of HF was either ischemic (51 patients—39.2%) or dilated (24 patients—18.4%) cardiomyopathy in the majority of the patients (75 patients—57.6%). Rest of the diagnosis for HF were hypertrophic cardiomyopathy in 6 (4.6%) patients, chronic rheumatic heart disease in 18 (13.8%) patients, primary pulmonary arterial hypertension in 6 (4.6%) patients, severe valvular pulmonary restenosis in 3 (2.3%) patients, Cor-pulmonale in 6 (4.6%) patients, and others in 16 (12.3%) patients. Events occurred in 17 patients (13.1%). Mortality occurred in 6 patients (4.62%). Patients with events had more severe dyspnea with pedal edema with low systolic blood pressure clinically; all patients had ECG abnormalities with more severe left ventricular (LV) dilatation with right and LV dysfunction with significant functional mitral regurgitation (MR) with more laboratory abnormalities including grossly elevated N-terminal pro B-type natriuretic peptide (NT pro-BNP) levels when compared with patients without events. All the above said parameters were statistically significant (p < 0.05). Conclusion The common cause of HF admissions in ICCU was predominantly due to ischemic cardiomyopathy. Still, valvular heart diseases were accounting for 13.8% of admissions. High incidence of event rate (13.1%) despite the improvement in treatment strategies of ICCU patients in this new era, also the all-cause in-hospital mortality, was 4.62%. There were multiple clinical (degree of dyspnea, pedal edema, low systolic blood pressure), ECHO (LV dilatation with dysfunction, right ventricle dysfunction, significant MR), and laboratory parameters (pre-azotemia, anemia, thrombocytopenia, grossly elevated NT pro-BNP levels) to predict the in-hospital events.