IN-HOSPITAL MORTALITY OF PATIENTS WITH ACUTE HEART FAILURE AND IT‘S PREDICTORS

Purpose: To assess in-hospital mortality of  patients hospitalized for acute heart failure (AHF) and it‘s predictors.

Methods: During December 2004 and August 2007 we hospitalized 1253 patients with AHF of all aetiologies. We assessed length of hospital stay, in-hospital morality (IHM) and it’s relation to the type and aetiology of AHF, degree of chronic dyspnoea before the admission by the NYHA classification and to the level of left ventricular ejection fraction (LV EF).

Results: Median length of hospital stay was 7 days with IHM 14,7%. There was no difference by IHM of patients with new onset AHF (16,3% died) and acute decompensation of chronic heart failure (12,4%) (p=0,064). There was correlation between IHM and aetiology of AHF (p<0,001). The worst IHM had acute coronary syndromes (ACS, 24,1%), massive pulmonary embolism (PE) with right AHF (67,2%) and chronic valve regurgitation (7,9%). A relation between IHM and NYHA class of dyspnoea prior to the hospital admission was found (p=0,005). The paradox is that the highest IHM had NYHA class 1-1,5 (16,9% patients died in this group), because of the highest occurrence of fatal ACS and PE in this group (together 86,2%) in comparison to NYHA class 3-4 with IHM 8,5% and fatal ACS and PE of 25%. Finally we found relation between IHM and level of LV EF (p=0,018). Patients with LV EF < 30% presented with the worst IHM (13,1% died), patients with LV EF>50% had IHM 8,5%.

Conclusion: We found relation between in-hospital mortality and aetiology of AHF, chronic class of dyspnoea by the NYHA classification and level of LV EF. There was no correlation between mortality and type of AHF (de novo AHF, acute decompensation of chronic heart failure).