In-hospital prognosis of patients with primary and secondary acute heart failure diagnosis
Authors: Apostolou E , Rafouli-Stergiou P , Liori S , Bistola V , Polyzogopoulou E , Doumanis G , Cholevas N , Frogoudaki A , Ikonomidis I , Parissis J 
Published: November 2020

Abstract

Introduction
Secondary acute heart failure (AHF) during hospitalization for another primary diagnosis is a frequent in-hospital complication.

Purpose
This analysis aims to describe differences in prognosis of these patients in comparison with patients admitted for AHF (primary AHF diagnosis) and also identify factors associated with in-hospital mortality.

Methods
This is a sub-analysis of the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF), which enrolled 4953 patients from 9 countries. All parameters univariately associated with in-hospital mortality in the primary and secondary AHF groups were included in the multivariate logistic regression model.

Results
Secondary AHF diagnosis was observed in 24.1% (N=1196) of the total study cohort. These patients demonstrated almost double all-cause in-hospital mortality rates compared to patients with primary AHF (16.9% versus 8.9%, p&lt;0.001).
In patients with primary AHF, negative prognostic factors included older age (&gt;75 years) (OR 2.01, 95% CI 1.24–3.26, p=0.004), acute coronary syndromes (ACS) (OR 2.71, 95% CI 1.57–4.69, p&lt;0.001), chronic renal disease (OR 2.02, 95% CI 1.13–3.61, p=0.017), presence of cold extremities (OR 2.04, 95% CI 1.23–3.40, p=0.006), in-hospital treatment with CPAP (OR 2.55, 95% CI 1.20–5.41, p=0.014), dobutamine (OR 2.55, 95% CI 1.52–4.28, p&lt;0.001), dopamine (OR 3.03, 95% CI 1.74–5.27, p&lt;0.001) and noradrenaline (OR 4.76, 95% CI 2.32–9.76, p&lt;0.001). Favorable predictors were systolic blood pressure ≥100 mmHg on admission (OR 0.54, 95% CI 0.31–0.94, p=0.031), in-hospital treatment with ACEIs (OR 0.07, 95% CI 0.03–0.16, p&lt;0.001), ARBs (OR 0.30, 95% CI 0.13–0.70, p=0.005) and vitamin-K antagonists (OR 0.06, 95% CI 0.007–0.44, p=0.006).
In secondary AHF, independent predictors of in-hospital mortality included left ventricular ejection fraction (LVEF) &lt;40% (OR 2.36, 95% CI 1.17–4.75, p=0.016), age &gt;75 years (OR 2.23, 95% CI 1.09–4.54, p=0.026), ACS (OR 3.55, 95% CI 1.50–8.39, p=0.004), diabetes (OR 2.26, 95% CI 1.23–4.16, p=0.008), pre-admission treatment with digoxin (OR 7.27, 95% CI 1.83–28.87, p=0.005), in-hospital medication with dobutamine (OR 2.43, 95% CI 1.28–4.61, p=0.006), dopamine (OR 2.29, 95% CI 1.12–4.67, p=0.022) and noradrenaline (OR 4.14, 95% CI 1.76–9.76, p=0.001). Covariates independently associated with survival benefit in secondary AHF were pre-admission treatment with diuretics (OR 0.29, 95% CI 0.09–0.88, p=0.030) and in-hospital treatment with ACEIs (OR 0.17, 95% CI 0.07–0.39, p&lt;0.001) and aspirin (OR 0.27, 95% CI 0.11–0.69, p=0.006).

Conclusion
Patients with secondary AHF experienced a more complicated in-hospital course with worse prognosis, compared to primary AHF. LVEF &lt;40%, age &gt;75 years, ACS, diabetes, pre-admission treatment with digitalis, in-hospital medication with dobutamine, dopamine and noradrenaline were identified as independent negative prognostic factors of in-hospital mortality in secondary AHF patients.

Funding Acknowledgement
Type of funding source: None