Short-term outcomes of acute heart failure hospitalizations in Ethiopia: A multicenter prospective study

Objectives: To determine the incidence and predictors of unplanned 30-day readmission and in-hospital mortality among adults hospitalized with AHF in Ethiopia. Methods: A multicenter prospective observational study was conducted in six referral hospitals in the Amhara region between December 2023 and April 2024. Adults (≥18 years) with AHF were consecutively enrolled and followed up until discharge and 30 days post-discharge. Kaplan-Meier survival analysis and Cox regression were used to estimate outcomes and predictors. Results: Of the 1131 patients, 275 (24.4 %) were readmitted within 30 days and 121 (10.7 %) died in the hospital. Independent predictors of readmission included hyponatremia (AHR = 10.5; 95 % CI: 3.1-36.2), thrombocytopenia (AHR = 16.7; 95 % CI: 4.8-58.3), ischemic heart disease (AHR = 6.9; 95 % CI: 1.8-27.0), Charlson Comorbidity Index ≥4 (AHR = 6.5; 95 % CI: 1.7-24.6), poor physician adherence to guideline-directed therapy (AHR = 8.2; 95 % CI: 2.3-30.1), and low patient adherence (AHR = 4.8; 95 % CI: 1.6-14.5). Prescription of ACE inhibitors, beta-blockers, and SGLT2 inhibitors at discharge significantly reduced the readmission risk (AHR range: 0.09-0.30). The predictors of in-hospital mortality included reduced ejection fraction, tachycardia, hypoxemia, left bundle branch block, pulmonary hypertension, elevated creatinine, severe hypertension, and pneumonia. Conclusion: AHF patients in Ethiopia experience high short-term readmission and mortality. Correcting electrolyte imbalances, improving comorbidity management, strengthening physician adherence to guideline-directed therapy, and promoting patient adherence are essential for improving outcomes.