Development of Acute Decompensated Heart Failure Among Hospital Inpatients: Incidence, Causes and Outcomes

Area of Science:

• Cardiology
• Hospital Medicine
• Public Health

Background:

• Acute decompensated heart failure (ADHF) developing during inpatient stays represents a significant clinical challenge.
• Understanding the incidence, triggers, and consequences of hospital-acquired ADHF is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) occurring during hospitalization.
• To identify factors associated with the development of ADHF in an inpatient setting.

Main Methods:

• A case-control study was conducted in a tertiary referral hospital involving medical, oncology, surgical, and orthopaedic wards.
• Cases of ADHF were matched with controls by age, gender, presenting complaint/surgery, and comorbidities. Multivariate regression analysis was used to identify associated variables.

Main Results:

• The incidence of ADHF was 1.0%. Key precipitants included infection (30%), intravenous fluid management (23.8%), and medication errors (8.8%).
• Factors associated with ADHF were non-preferred English language, history of ischemic heart disease, and administration of >2000ml IV fluid prior to ADHF.
• Cases experienced significantly longer hospital stays (15 vs. 6 days) and higher mortality (12.5% vs. 1.3%) compared to controls.

Conclusions:

• New-onset ADHF during hospitalization is a frequent occurrence, with a notable proportion being iatrogenic.
• Hospitalized patients who develop ADHF face significantly increased length of stay, morbidity, and mortality.