Effect of Precipitating Factors on Acute Decompensated Heart Failure

Abstract

Background: Acute decompensated heart failure (ADHF) is a life-threatening clinical event requiring urgent medical care and hospitalisation; identifying modifiable precipitating factors and evaluating short-term clinical outcomes after admission are crucial to improve risk stratification, optimise inpatient management and prevent early hospital readmissions.

Objective: To systematically evaluate the main precipitating factors for acute decompensation of heart failure patients and to analyse short term outcomes including length of hospital stay, discharge status, 30-day readmissions, intensive care unit (ICU) admissions, emergency department (ED) revisits and inpatient complications.

Methodology: A prospective observational study was conducted for a period of six months, including 98 patients, as per the inclusion criteria. Demographic data and relevant clinical data were collected using a validated patient profile form. Medication Adherence using MMAS-4, binomial logistic regression modelling and Chi-Square tests were done using SPSS version 22.0.  

Results: Heart failure with reduced ejection fraction (HFrEF, EF≤40%) was the predominant phenotype, with Hypertension (76.53%) and type 2 diabetes mellitus (60.20%) as the most prevalent comorbidities. Dyspnea was present in all patients. Anaemia was observed as the major precipitating factor. The majority of the patients were non-adherent (70.40%) to medications. At discharge, 68.36% were clinically stabilised, while a few patients were referred due to clinical worsening. Inpatient complications developed in 86.73% of patients, dominated by persistent anaemia (71.42%) and worsening renal function (42.85%). The study found active smoking (OR=0.080) and acute myocardial infarction (OR=0.167) were significant predictors of extended hospital stay; infection was a strong predictor of readmission (OR=0.120), and acute myocardial infarction independently predicted a worsened discharge status (OR=8.161). Chi-square testing confirmed a significant association between myocardial infarction and worsened discharge condition (p<0.05).

Conclusion: Anaemia, medication non-adherence, cardiac arrhythmias, and systemic infections are the primary modifiable triggers driving ADHF hospitalisations. Early clinical recognition of these precipitants, aggressive treatment of underlying ischemia, and targeted multidisciplinary pharmacist-led adherence interventions are crucial strategies to optimise short-term outcomes, prevent clinical deterioration, and minimise readmissions.