Clinical Presentation, Management and Outcome of Heart Failure Patients

Abstract

Background: Heart failure is a major public health issue with rising hospitalizations and high mortality. This study was conducted to assess the clinical presentation, management and outcome of heart failure patients presenting to a tertiary care hospital.
Methods: A prospective, observational study was conducted at a tertiary cardiac center in Nepal over a period of six months among admitted patients aged 18 years and above with heart failure. Data on demographics, etiology, treatment, and outcomes were collected via structured interviews, chart review, clinical observation, phone calls and follow-up. Etiologies were defined per standard criteria and patients were categorized according to the clinical and echocardiographic diagnosis.
Results: Among 1523 patients included, the mean age of the cohort was 61.5 ± 14.9 years, and 62.0 % were male. Coronary artery disease (65.8%) was the most common etiology, followed by idiopathic dilated cardiomyopathy (15.0%) and rheumatic heart disease (7.2%). Acute coronary syndrome (39.9%) was the primary aggravating factor. Guideline-directed medical therapy use included Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker (68.5%), Beta-blockers (66.1%), and Mineralocorticoid Receptor Antagonists (61.2%); however, the use of Sodium-Glucose Cotransporter-2 inhibitors was low (15.2%). Device therapy was rare (0.26%). The overall mortality rate was 12.7%, comprising 4.7% in-hospital mortality and 7.9% 90-day mortality.
Conclusions: Coronary artery disease is the commonest etiology, with Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker as the commonest prescription, followed by Beta-blockers and Mineralocorticoid Receptor Antagonists, with device therapy being rare, with an overall mortality of 12.7%.
Keywords: Coronary artery disease; dilated cardiomyopathy; guideline-directed medical therapy; heart failure.