Clinico-Biochemical Profiles and Outcomes in Acute Decompensated Heart Failure

Background  Acute decompensated heart failure (ADHF) is a major global health concern with rising prevalence in India, marked by earlier onset, high mortality, and frequent hospitalizations. This study aims to compare the risk factors, clinical and biochemical profiles, and in-hospital outcomes of ADHF patients with preserved versus reduced ejection fraction, addressing a key gap in Indian data. Materials and methods  A cross-sectional observational study was conducted in the Department of Medicine at MM Institute of Medical Sciences and Research, Mullana, enrolling 100 consecutive patients aged ≥18 years with a confirmed diagnosis of heart failure according to the American College of Cardiology/American Heart Association/Heart Failure Society of America (2022 guidelines) (ACC/AHA/HFSA) 2022 definition. Patients with congenital heart disease, chronic cor pulmonale, or rheumatic heart disease were excluded. After informed consent, all participants underwent detailed history-taking, clinical examination, and investigations, and were followed until discharge or death. Data were analyzed using SPSS v26.0 with descriptive and inferential statistics, with p < 0.05 considered statistically significant. Results  Overall, 52% of patients had heart failure with reduced ejection fraction (HFrEF) and 48% had heart failure with preserved ejection fraction (HFpEF), with a male predominance and a mean age of 62.3 years. Anemia and sepsis were common precipitating factors, while hypertension, obesity, and chronic obstructive pulmonary disease (COPD) were more associated with preserved ejection fraction (EF). In-hospital mortality was 10%. Elevated total leukocyte count (TLC), N-terminal pro-B-type natriuretic peptide (NT-proBNP), serum creatinine, and shock were significantly linked to poorer outcomes, with creatinine emerging as a strong predictor of mortality. Conclusion  This study highlights the diverse clinico-biochemical profile of ADHF patients and the high prevalence of comorbidities. Significant differences were observed between preserved and reduced EF groups. Despite these variations, in-hospital mortality did not differ significantly, emphasizing the need for comprehensive risk assessment beyond ejection fraction to guide timely, individualized management in ADHF.