Early predictors of in-hospital mortality in patients with acute heart failure. A general hospital experience

Acute heart failure (AHF) is a life-threatening condition linked to high morbidity and mortality rates. Despite recent advancements in treatment, short- and long-term mortality remain substantial. This study aims to identify and highlight the factors associated with increased in-hospital mortality in patients with AHF.

This prospective single-center study examined patients hospitalized for acute heart failure (AHF) from February 2023 to September 2024. We collected data on demographic characteristics, comorbidities, clinical phenotypes, precipitating factors of AHF, chronic HF medication and admission laboratory parameters, including NT-proBNP, creatinine (Cr), serum albumin (Alb), estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c) etc. Echocardiographic parameters, such as left ventricular ejection fraction (LVEF), E/E' ratio, lateral tricuspid annulus peak systolic velocity (RV S’) and estimated pulmonary artery systolic pressure (ePASP), were recorded within the first 48 hours of hospitalization. The total number of in-hospital deaths was recorded while patients with insufficient data and already on renal replacement therapy were excluded from the study.

A total of 346 patients were included in the study, with 20 deaths (5.7%) overall. Data analysis identified several risk factors for in-hospital mortality due to acute heart failure (AHF), including cardiogenic shock, older age, lower systolic blood pressure, serum albumin, estimated glomerular filtration rate (eGFR), sodium, and hemoglobin (Hb) at admission, along with higher levels of NT-proBNP, troponin I (measured as 1 standard deviation), urea, and the E/E' ratio.

Interestingly, patients with the acute decompensated heart failure (ADHF) phenotype had lower in-hospital mortality rates, while uncontrolled blood pressure as the main precipitating factor was also associated with lower mortality outcomes.

Multivariate analysis revealed that serum albumin (HR 0.217, 95% CI 0.05-0.846, p=0.028), admission systolic blood pressure (HR 0.968, 95% CI 0.944-0.993, p=0.011), ADHF phenotype (HR 0.092, 95% CI 0.023-0.366, p<0.001), and high-sensitivity cardiac troponin I [hs-cTnI -measured as 1 standard deviation] (HR 1.457, 95% CI 1.016-2.090, p=0.041) were independent predictors of in-hospital mortality.