A comparative analysis of the characteristics and outcomes of de novo heart failure versus acutely decompensated chronic heart failure

Background Acute heart Failure (HF) encompasses a wide spectrum of clinical presentations, including de novo heart failure (DN-HF) and acutely decompensated chronic heart failure (AD-CHF). While DN-HF patients are often considered to be an earlier stage of HF and therefore with fewer comorbidities than AD-CHF, little is known about the specific differences in characteristics and outcomes when compared to AD-CHF patients. Purpose To compare patient characteristics and clinical outcomes between patients with DN-HF and AD-CHF. Methods This is a retrospective cohort study recruiting all patients registered in the Qatar Heart Failure Registry of the largest advanced HF center in the country, which receives more than 95% of all HF admissions. Patients were categorized into two groups: 1) DN-HF, defined as the first admission for HF symptoms with no prior history of CHF; and 2) AD-CHF, defined as patients with a history of CHF experiencing an acute decompensation. Continuous variables were reported as mean with standard deviation and categorical variables as frequency distribution with percentage. Student t and Chi-squared tests were used for continuous and categorical variables, respectively. Results Of 710 patients, 261 (36.76%) patients presented as DN-HF and 449 (63.24%) patients as AD-CHF. Patients with DN-HF were predominantly males (78.16% vs. 66.8%) and had significantly lower rates of comorbidities such as hypertension (81.99% vs. 89.53%), diabetes (68.58% vs. 79.28%), and coronary artery disease (51.34% vs 82.73%) than those with AD-CHF. Patients with DN-HF tend to have ischemic etiology of HF (63.98% vs. 55.01%) without a difference in terms of HF phenotypes, left ventricular ejection fraction (LVEF), or natriuretic peptide levels upon presentation. Patients presenting with DN-HF experienced significantly lower rates of readmission (7.66% vs. 25.39%) and 30-day readmission (1.53% vs. 4.45%) with numerically shorter time to first readmission (5.47 vs. 7.46 months). There was no statistical difference between the two cohorts in terms of length of hospital stay (16.88±51.92 vs. 21.02±60.40 days) and in-hospital mortality rate (2.30% vs. 4.23%) (Table 1). Conclusion(s) DN-HF is a distinct phenotype of acute HF with a noticeable difference in terms of baseline characteristics and HF etiology compared with AD-CHF without a difference in terms of HF phenotypes or LVEF. Patients with DN-HF experienced lower readmission rates without a difference in rates of in-hospital mortality.Characteristics and outcomes