Incidence of acute heart failure with and without concomitant pulmonary disease

Acute heart failure (AHF) is the primary diagnosis in over one million emergency department (ED) hospitalizations each year in the United States (USA). The patients are often comorbid, with several competing causes for their symptoms, especially pulmonary diseases. The purpose of this study is to investigate the incidence and characteristics of patients admitted with AHF with and without concomitant pulmonary disease, compared to patients without AHF, in a large hospital in Denmark. Secondly, to investigate the mortality rate in AHF and how it is influenced by concomitant pulmonary disease.

We conducted a prospective cohort study at the medical ED at a large university hospital in Denmark in a two-year period during the Corona Virus Disease pandemic. Patient records were screened by trained cardiologists, to identify patients admitted with AHF. The cohort was stratified by AHF status and concomitant pulmonary disease.

We included 7258 patients, of whom found 408 (5.6 %) patients had AHF. In the group with AHF, 106 patients (26 %) had a competing concomitant pulmonary cause of admission. The incidence rate for admission with AHF was 91/100.000 inhabitants/year. In a multivariable cox regression model, AHF was independently associated with mortality with an adjusted hazard ratio of 1.34 (1.13-1.58), p value <0.001. Pulmonary disease was associated with a worse prognosis in the group with AHF (HR_adj 1.74 (1.24-2.44), p-value < 0.001).

In this prospective observational cohort study, 5-7 % of all admissions to the medical ED was caused by AHF, and was associated with worse outcomes than patients without AHF. Concomitant pulmonary admission disease was associated with a worse prognosis among patients with AHF.