Predictors for Developing Acute Decompensated Heart Failure During Hospitalization

Background:

Acute decompensated heart failure (ADHF) that develops during hospitalization is a potentially preventable problem that has not been well studied. A significant proportion of ADHF cases during hospitalization has been attributed to intravenous fluid hydration(25.5% in one study). Our purpose is to estimate the incidence of ADHF that develop during hospitalization in hospitalized medical patients and to identify possible predictors of this complication.

Methods:

We assembled a retrospective cohort of 1435 patients admitted to regular nursing floor general internal medicine beds in a tertiary care center in the period June 1^st‐August 31^st, 2013. The incidence of acute congestive heart failure (ADHF) that developed during hospitalization (not on admission) was calculated. Based on the calculated incidence, the outcome was considered rare and therefore a nested case control study was constructed. Seven cases were compared to twenty‐eight controls randomly selected from the cohort.

Results:

The incidence of ADHF that developed during hospitalization was 7/1435 (0.49%) of hospital admissions in our study. Six out of the seven ADHF cases were clinically attributed to intravenous fluid (IVF) hydration and one case was attributed to holding diuretics on admission. In the nested case control study, summary measures of pertinent baseline characteristics were calculated (Table 1). Univariate logistic regression analysis was used to evaluate the associations between ADHF and possible predictors prior to building a multivariate logistic regression model that included gender, history of coronary artery disease (CAD), history of CHF and total amount of IVF in liters. In the multivariate logistic regression model, ADHF during hospitalization was found to be significantly associated with prior history of CHF [OR 43.6 (2.18‐872.19),p=0.013]. Gender, history of CAD, and total amount of IVF were not significantly independently associated with ADHF during hospitalization.

Conclusions:

Prior history of congestive heart failure is a strong predictor of ADHF during hospitalization. Other factors such as age, gender, creatinine (Cr) on admission, history of CAD, history of hypertension (HTN), total amount of IVF, or average IVF infusion rate were not found to be associated with ADHF during hospitalization. Further, larger studies are needed to help further identify patients at risk of developing ADHF during hospitalization in order to institute prevention measures.