Acute heart failure in a tertiary emergency department in Thailand: clinical characteristics and factors associated with in-hospital mortality

Background Acute heart failure (AHF) is a major cause of emergency department (ED) visits and is associated with significant morbidity and mortality. In Thailand, real-world data on AHF presentations and outcomes in the ED remain limited, particularly in resource-constrained settings. This study aimed to describe the clinical characteristics, treatment, and outcomes of AHF patients in a tertiary care ED in Northeastern Thailand and identify factors associated with in-hospital mortality. Methods We conducted a retrospective cohort study of adult patients (≥ 18 years) diagnosed with AHF at the ED of Srinagarind Hospital between October 2021 and March 2023. Patients transferred from other hospitals or who were pregnant were excluded. Clinical data were extracted from electronic health records. The primary outcome was in-hospital mortality. Univariable and multivariable logistic regression analyses were performed to identify factors independently associated with in-hospital mortality. Results Of 902 eligible AHF patients, the median age was 71 years (IQR: 60–80), and 52.0% were male. The in-hospital mortality rate was 6.0%. Non-survivors were more likely to have a history of congestive heart failure, chronic kidney disease, or cerebrovascular accident, and presented with lower diastolic blood pressure and oxygen saturation. They were also more likely to be triaged as Emergency Severity Index (ESI) level 1 and require ICU admission, ventilatory support, and inotropic support. In multivariable analysis, the need for inotropic support was the only variable independently associated with in-hospital mortality (adjusted OR 3.97; 95% CI 1.91–8.40; p < 0.001). Conclusion In this ED-based cohort, the in-hospital mortality of patients with acute heart failure was comparable to international reports. The need for inotropic support was strongly associated with hospital mortality, likely reflecting severe hemodynamic compromise.