Predicting outcome in acute heart failure, does it matter?

BACKGROUND: Acute heart failure (AHF) is a cardiac condition with multiple aetiologies that carries a high fatality rate. The development of heart failure following a coronary event has a poor prognosis. The main aim of this study was to predict in-hospital and long-term prognosis of AHF based on co-morbidities, physical and paraclinical findings at the time of admission. METHODS: The charts from 366 AHF patients, admitted for the first time during a 4-year period at a major university hospital, were reviewed. In addition to the demographic information, a comprehensive social and medical history was obtained. Presenting symptoms and physical findings were also recorded along with admission values of laboratory and myocardial injury markers. Echocardiographic examination was performed and recorded. Angiographic findings were only recorded in patients with acute coronary ischaemia. Univariate and multivariate analyses were performed to examine the relative contribution of clinical factors on in-hospital and long-term mortality. RESULTS: Preceding acute coronary syndrome (STEMI/NSTEMI) was the strongest predictor of in-hospital death for AHF (OR 3.74; 1.94-7.22, P = 0.001). Multivariate binary logistic regression identified that older age, female gender presence of acute myocardial infarction (higher cTNI or higher CKMB levels), lower blood pressure, lower LVEF and higher WBC were independently associated with long-term mortality. CONCLUSION: AHF following an acute coronary syndrome carries a higher fatality rate. Higher levels of cardiac injury markers and white blood cell counts may present as a poor prognostic indicator secondary to an acute ischaemic event.