The predictive value of precipitating factors on clinical outcomes in hospitalized patients with decompensated heart failure: insights from the Egyptian cohort in the European Society of Cardiology Heart Failure long-term registry

Abstract

Background Knowledge of the frequency of precipitating factors for acute heart failure (AHF) is important (either new-onset heart failure [NOHF] or worsening heart failure [WHF]), as this can guide strategies for prevention and treatment. Most data come only from Western Europe and North America; nevertheless, geographic differences do exist. We set out to study the prevalence of precipitating factors of AHF and their connection to patient characteristics and in-hospital and long-term mortality in patients from Egypt hospitalized for decompensated HF. Using the ESC-HF-LT Registry which is a prospective, multicenter, observational study of patients confessed to cardiology centers in the nations of Europe and the Mediterranean, patients presenting with AHF were recruited from 20 centers all over Egypt. Enrolling physicians were requested to report possible precipitants from among several predefined reasons. Results We included 1515 patients (mean age 60 ± 12 years, 69% males). The mean LVEF was 38 ± 11%. Seventy-seven percent of the total population had HFrEF, 9.8% had HFmrEF, and 13.3% had HFpEF. The commonly reported precipitating factors for AHF hospitalization among study population were as follows (in decreasing order of frequency): infection in 30.3% of patients, acute coronary syndrome/myocardial ischemia (ACS/MI) in 26%, anemia in 24.3%, uncontrolled hypertension in 24.2%, atrial fibrillation (AF) in 18.3%, renal dysfunction in 14.6%, and non-compliance in 6.5% of patients. HFpEF patients had significantly higher rates of AF, uncontrolled hypertension, and anemia as precipitants for acute decompensation. ACS/MI were significantly more frequent in patients with HFmrEF. WHF patients had significantly higher rates of infection and non-compliance, whereas new-onset HF patients showed significantly higher rates of ACS/MI and uncontrolled hypertension. One-year follow-up revealed that patients with HFrEF had a significantly higher rate of mortality compared to patients with HFmrEF and HFpEF (28.3%, 19.5, and 19.4%, P = 0.004). Patients with WHF had a significantly higher rates of 1-year mortality when compared to those with NOHF (30.0% vs. 20.3%, P < 0.001). Renal dysfunction, anemia, and infection were independently connected to worse long-term survival. Conclusions Precipitating factors of AHF are frequent and substantially influence outcomes after hospitalization. They should be considered goals for avoiding AHF hospitalization and depicting those at highest risk for short-term mortality.

The effect of kidney function on guideline‐directed medical therapy implementation and prognosis in heart failure with reduced ejection fraction

“… 53 In the REPORT‐HF registry, patients hospitalized for acute decompensated HF and patients with worsening renal function had the highest mortality rates. 54 In accordance with our findings, in the international cohort study by Lam et al, renal function was not revealed as an independent predictor of mortality. However, age and systolic blood pressure had a significant effect.…”

“…As for acute HF patients, in the recent publication of Lorlowhakarn et al, age, cardiovascular accidents, and NT‐proBNP level were associated with higher 1‐year mortality after acute HF hospitalization 53 . In the REPORT‐HF registry, patients hospitalized for acute decompensated HF and patients with worsening renal function had the highest mortality rates 54 . In accordance with our findings, in the international cohort study by Lam et al, renal function was not revealed as an independent predictor of mortality.…”

Regional expert opinion: Management of heart failure with preserved ejection fraction in the Middle East, North Africa and Turkey

“…Analysis of data from the Egyptian cohort in the European Society of Cardiology (ESC) HF long-term registry (ESC-HF-LT-R) revealed that patients who were hospitalized for acute HFpEF had a 1-year mortality rate of 19.4%. 23 According to the Gulf CARE registry, which enrolled patients hospitalized for acute HFpEF in the Arabian Gulf, 1-year mortality was lower at 8.1%; however, 1-year HF hospitalization rates were high at 27%. 24 Much of the burden related to HFpEF can typically be attributed to a high prevalence of co-morbidities, such as dia- betes, obesity, hypertension, anaemia, chronic kidney disease (CKD), atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) (Table 2).…”

“…HFpEF is associated with a high rate of morbidity and mortality, and patient survival is typically poor. Analysis of data from the Egyptian cohort in the European Society of Cardiology (ESC) HF long‐term registry (ESC‐HF‐LT‐R) revealed that patients who were hospitalized for acute HFpEF had a 1‐year mortality rate of 19.4% 23 . According to the Gulf CARE registry, which enrolled patients hospitalized for acute HFpEF in the Arabian Gulf, 1‐year mortality was lower at 8.1%; however, 1‐year HF hospitalization rates were high at 27% 24 …”

“…Much of the burden related to HFpEF can typically be attributed to a high prevalence of co‐morbidities, such as diabetes, obesity, hypertension, anaemia, chronic kidney disease (CKD), atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) ( Table 2 ). 1 , 9 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Patients with HFpEF often have poor QoL, similar to patients with end‐stage renal disease, and have substantial limitations to their daily activities. 22 , 30 However, despite the established negative effect on QoL, variability exists in how these co‐morbidities can affect patient outcomes.…”