Development of Acute Decompensated Heart Failure Among Hospital Inpatients: Incidence, Causes and Outcomes

We aimed to investigate the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) that develops during the inpatient stay. We undertook a case-control study in the medical, oncology, surgical, and orthopaedic wards of a tertiary referral hospital (February–May, 2016). Pat...

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Bibliographic Details
Published in:Heart, lung & circulation lung & circulation, 2019-03, Vol.28 (3), p.406-413
Main Authors: Plant, Luke D., Taylor, David McDonald, Worland, Thomas, Puri, Arvind, Ugoni, Antony, Patel, Sheila K., Johnson, Douglas F., Burrell, Louise M.
Format: Article
Language:English
Subjects:
Acute decompensated heart failure
Iatrogenic
Inpatients
Intravenous fluids
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Summary:We aimed to investigate the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) that develops during the inpatient stay. We undertook a case-control study in the medical, oncology, surgical, and orthopaedic wards of a tertiary referral hospital (February–May, 2016). Patients aged ≥18 years who developed ADHF during their inpatient stay were enrolled as cases. One control patient was matched to each case by age, gender, presenting complaint/surgery performed and co-morbidities. Multivariate regression was employed to determine variables associated with ADHF. The incidence of ADHF was 1.0% of patients. Eighty cases were well-matched to 80 controls (p>0.05). ADHF precipitants comprised infection (30%), inappropriate intravenous (IV) fluid and medication management (23.8% and 8.8%, respectively), tachyarrhythmia (12.5%), ischaemic heart disease (8.8%), renal failure (1.3%), and other/unclear causes (15%). Three variables were associated with ADHF: not having English as the preferred language (OR 3.5, 95%CI 1.2–9.8), a history of ischaemic heart disease (OR 3.3, 95%CI 1.2–9.1), and the administration of >2000ml of IV fluid on the day before the ADHF (OR 8.3, 95%CI 1.5–48.0). The day before the ADHF, cases were administered significantly more IV fluids than controls (median 2,757.5 versus 975ml, p=0.001). Medication errors mostly related to failure to restart regular diuretics. Cases had significantly greater length of stay (median 15 versus 6 days, p
ISSN:1443-9506
1444-2892
DOI:10.1016/j.hlc.2017.12.004