Impact of heart failure on in-hospital mortality during admissions for other conditions

Acute heart failure (AHF) is a frequent cause of hospitalization and has been extensively studied. However, its characteristics when it appears secondarily during admission for other pathologies are less well defined. The aim of this study was to analyze the clinical characteristics, prognostic factors and evolution of AHF in patients hospitalized for other causes, diagnosed by interconsultation to Internal Medicine (IM).

Observational study that included patients diagnosed with AHF after consultation with IM (2020-2022). Demographic and clinical characteristics, admission reasons, type of heart disease, triggering factors, in-hospital mortality and associated factors were collected.

Of 1583 consultations, 347 patients (21.9%) were diagnosed with AHF. The mean age was 79.9 (±10.3 years) and 184 (53%) were female. 76% came from surgical services. The most frequent comorbidities were hypertension, dyslipidemia and atrial fibrillation. Most patients had hypertensive etiology and preserved ejection fraction (68.6%). The main triggers were infections, anemia and fluid overload. In 50% of the cases, AHF was the debut of HF. In-hospital mortality was 20.5%, 26.4% at one-year follow up, and 39.7% were readmitted. In-hospital mortality was associated with older age (p = 0.031), elevated NT-proBNP (p = 0.048) and lower hemoglobin (p = 0.004) and albumin (p = 0.006) levels.

Patients who develop AHF during admission for other pathologies present advanced age, multiple comorbidities and high mortality. Early detection of triggering factors and identification of prognostic factors could help to optimize their management and improve their outcome.