Clinical Profile and Predictors of In-Hospital Mortality in Patients with Acute Heart Failure in a Tertiary Care Hospital

Acute heart failure (AHF) represents a rapid onset or worsening of symptoms and signs of heart failure, requiring urgent medical attention and hospitalization. It is a leading cause of morbidity and mortality globally, especially among the elderly population. Despite advances in diagnostic and therapeutic strategies, AHF continues to be associated with high in-hospital mortality rates ranging from 4% to 15%.

The clinical course of AHF is highly heterogeneous, influenced by underlying etiology, comorbidities, hemodynamic status, and response to therapy. Identifying predictors of mortality during hospitalization is crucial for early risk stratification and targeted management.

Common risk factors associated with poor outcomes include advanced age, renal dysfunction, hypotension, hyponatremia, reduced left ventricular ejection fraction (LVEF), and elevated natriuretic peptide levels. However, the relative contribution of these factors varies across populations.

This study aims to evaluate the clinical profile of patients with AHF and identify independent predictors of in-hospital mortality in a tertiary care setting.

Study Design and Setting

A prospective observational study was conducted in a tertiary care teaching hospital over a period of 18 months.

Study Population

Patients aged ≥18 years admitted with a diagnosis of acute heart failure based on Framingham criteria and echocardiographic evidence were included.

Exclusion Criteria

·       Acute myocardial infarction as primary diagnosis

·       End-stage renal disease on dialysis

·       Congenital heart disease

·       Terminal malignancy

Data Collection

Detailed history, clinical examination, and investigations were recorded, including:

·       Vital signs (blood pressure, heart rate, oxygen saturation)

·       Laboratory parameters (CBC, renal function tests, electrolytes, NT-proBNP)

·       ECG findings

·       Echocardiography (LVEF, wall motion abnormalities)

Outcome Measure

Primary outcome was in-hospital mortality.

Statistical Analysis

Data were analyzed using SPSS software. Continuous variables were expressed as mean ± SD and categorical variables as percentages. Univariate and multivariate logistic regression analyses were performed to identify predictors of mortality. p < 0.05 was considered statistically significant.

Baseline Characteristics

·       Total patients: 220

·       Mean age: 62.4 ± 13.8 years

·       Male: 58% (n = 128)

·       Female: 42% (n = 92)

Etiology of AHF

Clinical Features

·       Dyspnea (92%)

·       Pedal edema (74%)

·       Orthopnea (68%)

·       Raised JVP (61%)

·       Pulmonary edema (39%)

Laboratory and Echocardiographic Findings

·       Mean LVEF: 38.6 ± 12.4%

·       Serum creatinine >2 mg/dL: 31%

·       Hyponatremia (<130 mEq/L): 27%

·       Elevated NT-proBNP: 78%

Outcomes

·       Survivors: 188 (85.5%)

·       Non-survivors: 32 (14.5%)

Predictors of In-Hospital Mortality

This study demonstrates that in-hospital mortality in AHF remains significant at 14.5%, consistent with previous studies reporting mortality between 10–15%.

Ischemic heart disease was the leading cause, reflecting the increasing burden of coronary artery disease in developing countries. Hypotension and cardiogenic shock were the strongest predictors of mortality, highlighting the importance of hemodynamic instability as a key determinant of outcomes.

Renal dysfunction emerged as a major independent predictor, likely due to cardiorenal syndrome, which worsens fluid overload and limits therapeutic options. Hyponatremia also showed strong association with poor outcomes, reflecting neurohormonal activation and severe disease state.

Reduced LVEF (<30%) remained an important echocardiographic predictor, consistent with prior studies showing that severe systolic dysfunction correlates with worse prognosis.

Elevated NT-proBNP levels were significantly associated with mortality, supporting its role as a biomarker of ventricular stress and severity.

Early identification of these predictors can help clinicians triage patients to intensive care, optimize therapy, and potentially reduce mortality.

Acute heart failure continues to be associated with high in-hospital mortality. Key predictors include hypotension, renal dysfunction, hyponatremia, reduced ejection fraction, elevated NT-proBNP, and cardiogenic shock. Early risk stratification using these parameters can improve clinical outcomes and guide intensive management strategies.

Limitations

·       Single-center study

·       Moderate sample size

·       Lack of long-term follow-up

·       Biomarker variability not serially assessed

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