Precipitants of Acute Decompensated Heart Failure and their Correlation with the Severity of Decompensation in a Resource Poor Country
Objective: 1. To determine the frequency of various factors (patient related, disease related and physician related), causing immediate precipitation of congestive cardiac failure in a tertiary care hospital. 2. To establish correlation between these variables and severity of decompensated heart failure.
Patients and Methods: This cross-sectional study was carried out over a period of March-August, 2016. All patients admitted to cardiology ward and Coronary Care Unit (CCU) of Pakistan Institute of Medical Sciences during the study period were enrolled in the study using consecutive sampling technique. An arbitrarily predetermined sample size of 115 patients was taken. Precipitants were classified as patient related, disease related and physician related. Data was recorded and analyzed using SPSS version 22. Qualitative variables were reported as percentages and quantitative variables by using mean ± standard deviation. Spearman correlation coefficient was used to determine the correlation between variables and outcome measures.
Results: A total of 115 patients were enrolled in this study. The mean age of the population was 51.13±13.6 years. Among these 38.3% of the population was obese. The patients remained admitted to the hospital for the index episode of decompensation for a mean period of 4.14±1.2 days. Infections were found to be the leading precipitant contributing to 57.6% of all decompensation episodes. This was followed by drug non-compliance (17.4%) and arrhythmias (8.7%). Ischemia was noted in 5.2%. Heart failure severity at presentation was found to correlate significantly with the presence of hypertension (Spearman coefficient 0.62, p-value 0.04), baseline hemoglobin (Spearman coefficient -0.58, p-value 0.03), creatinine levels (Spearman coefficient 0.71, p-value 0.05) and precipitant of heart failure (Spearman coefficient 0.257, p-value 0.007).
Conclusion: A sizeable majority of heart failure hospitalizations can be prevented by inculcating measures directed at effective infection control at community and health care level and educating patients regarding recognition of early signs of infection that may target the most important immediate precipitant for acute decompensated heart failure.
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