Key result
Cold and wet acute heart failure phenotype linked to 25% in-hospital mortality regardless of EF.
Why the study?
Heart failure epidemiology in India remains largely unexplored, with existing data limited to a few North Indian registries.
What are the clinical characteristics and in-hospital outcomes of patients admitted with acute heart failure in South India?
Observational (n=449)
No
What are the clinical characteristics and in-hospital outcomes of patients admitted with acute heart failure in South India?
In a South Indian acute heart failure registry, HFrEF was the most common presentation, and the cold and wet clinical phenotype was associated with higher in-hospital mortality and worsening renal function.
Answers are grounded in this paper and cite their sources.
Cold-wet phenotype flags high in-hospital mortality in acute HF irrespective of EF; hypothesis-generating for phenotype-guided risk models pending prospective validation.
BACKGROUND: The epidemiology of HF in India is largely unexplored. Current resources are based on a few hospital-based and a community-based registry from North India. Thus, we present the data from a single hospital-based registry in South India. Patients admitted with acute heart failure over a period of 1 year were enrolled in the registry and were characterized based on their ejection fraction (EF) measured by echocardiogram. The clinical profile of the patients was assessed, including their in-hospital outcomes. One-way ANOVA and univariate analysis were performed for comparison between three EF-based groups and for the assessment of in-hospital outcomes. RESULTS: A total of 449 patients were enrolled in the registry, of which 296, 90, and 63 patients were categorized as, HFrEF, HFmrEF, and HFpEF, respectively. The prevalence of HFrEF was higher (65.99%). The mean age (SD) of the study cohort was 59.9±13.3. The majority of the patients presented with acute denovo HF (67%) and were more likely to be males (65.9%). The majority of patients presented with warm and wet clinical phenotype (86.4%). In hospital mortality was higher in HFmrEF (3.3%). CONCLUSION: Patients with HFrEF had high adherence to guideline-directed medical therapy (GDMT). HFrEF patients were also likely to have longer hospital stay along with a worsening of renal function. The in-hospital mortality was comparable between the EF-based groups. Additionally, the association of clinical phenotypes with outcome highlighted that patients in warm and wet phenotype had a longer length of hospital stay, whereas the mortality and worsening renal function rates were found to be significantly higher in the cold and wet group.
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Shukkoor et al. (2021) conducted an observational in Acute heart failure (n=449). Ejection fraction categories (HFrEF, HFmrEF, HFpEF) vs. Compared among groups was evaluated on In-hospital mortality (p=0.137). In patients admitted with acute heart failure, in-hospital mortality was comparable across ejection fraction groups (1.6% HFrEF, 3.3% HFmrEF, 1.5% HFpEF), but significantly higher in those presenting with a cold and wet clinical phenotype (25%).
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