Analysis of Mortality from Multiple Causes in Heart Failure Categorized by Ejection Fraction

Mortality in heart failure (HF) may be underestimated when analyses rely solely on the underlying cause of death from death certificates (DCs), whereas including multiple causes of death enables a broader examination of mortality and its determinants.

To analyze the multiple causes of in-hospital and late death in patients with decompensated HF and reduced ejection fraction (EF) (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF).

Retrospective analysis of a prospective cohort of patients admitted for decompensated HF to a cardiac intensive care unit at a private hospital. The analysis included multiple causes of in-hospital and late deaths. A significance level of 5% was adopted.

The analysis included 519 individuals with a mean age of 74.87 ± 13.56 years, of whom 57.6% were male. The distribution of HFpEF, HFmrEF, and HFrEF was 25.4%, 27%, and 47.6%, respectively. Cardiovascular diseases (I) were the main causes of in-hospital and late death across all three EF groups, with no significant differences among them. The primary isolated causes of in-hospital and late death were septicemia (A41), HF (I50, I50.0, I50.9), and pneumonia (J12-J18). In late death, septicemia and pneumonia showed significant differences among the groups. Chronic respiratory causes were more frequent in patients with lower EF (HFrEF and HFmrEF). Correspondence analysis revealed an association between circulatory causes and HFrEF, neoplastic causes and HFpEF, and endocrine and metabolic causes and HFmrEF.

The analysis of multiple causes of death reveals a high rate of non-circulatory deaths in patients with decompensated HF, regardless of EF, linked to age and chronic comorbidities.