Comparative analysis of ischemic and non-ischemic etiology of acute heart failure - analysis from the "OP-AHF" registry
Authors: Dabrowska K , Wojcicki K , Chruscicki D , Plonka W , Giet M , Borys D , Krzypkowska M , Pelc M , Klimek M , Malaka E , Kucharska J , Plonka J , Gierlotka M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by a grant from the Institute of Medical Sciences, University of Opole, Poland. ROCHE Diagnostics Poland.

Introduction
Current guidelines of the European Society of Cardiology define acute heart failure as the rapid onset of symptoms and/or signs of heart failure, severe enough for the patient to seek urgent medical attention, leading to an unplanned hospital admission or an emergency department visit.

Purpose
The aim of this study was to compare clinical characteristics, treatment, and 12-month outcomes of patients with ischemic(I-AHF) and non-ischemic acute heart failure(NI-AHF).

Materials and Methods
As a part of the open prospective Acute Heart Failure Registry (OP-AHF),data 122 patients hospitalized in the Intensive Cardiac Care Unit were collected in the period from June 2019. The inclusion criteria were hospitalization for acute heart failure and the need to use at least one of: intravenous diuretics, catecholamines or mechanical circulatory support. The project was approved by the Bioethical Committee.

Results
Patients with ischemic etiology of acute heart failure (I-AHF) constituted 43% of the study group (53 of 122 patients). Compared to patients with non-ischemic etiology of acute heart failure (NI-AHF), patients with I-AHF were older (69 vs. 64 years, p = 0.04) and slightly more frequently male (79% vs. 67%, p=0.12). BMI was similar in both groups (29 vs. 30, p=0.21). On admission, they reported more frequently chest pain (49% vs. 33%, p = 0.08), and less frequently than NI-AHF patients, edema (40% vs. 54%, p = 0.12) and dyspnoea (91% vs. 97%, p =0.25). History of diabetes (60% vs. 20%, p&lt;0.01) and chronic kidney disease (38% vs. 20%, p =0.03) were predominant in I-AHF patients,but atrial fibrillation (36% vs 57%, p=0.02) was less common than in NI-AHF patients. Laboratory results on admission showed significantly higher NT-proBNP levels in the I-AHF patients (11078 vs 7785 pg/ml, p &lt; 0.004). Left ventricle ejection fraction (LVEF) was lower on admission (29% vs 35%, p= 0.02) and at discharge (34% vs 39%, p = 0.19) in I-AHF patients. At 12-month follow-up, there was no improvement of LVEF in I-AHF patients in contrast to NI-AHF patients (34% vs 47%, p &lt;0.001). Death during hospitalization occurred more frequently in the I-AHF patients group (15% vs 3%, p=0.01). The rates of cardiovascular rehospitalisations within 12 months was 23% in patients with I-AHF patients compared to 32% in NI-AHF patients, p=0.3;HR=0.70 (95% CI = 0.35-1.38). The risk of death from any cause within 12 months was lower in patients with I-AHF (17% vs. 32%, p=0.056; HR = 0.49 (95% CI = 0.23-1.02)), nevertheless, after adjustment for age, sex, LVEF and NT-proBNP, mortality was essentially identical in both groups, 24% inI-AHF and 23% in NI-AHF, p=0.99; HR=1.00 (0.45-2.24).

Conclusions
Despite a worse in-hospital outcomes, ischemic etiology of acute heart failure was not associated with a higher risk of cardiovascular rehospitalization and death at 12-month follow-up than non-ischemic etiology.