In-hospital Mortality and its Associated Factors among People with Acute Heart Failure Presented to Emergency Department at Haramaya University Hiwot Fana Comprehensive Specialized Hospital, Harar Eastern Ethiopia

Abstract

Background: Acute heart failure is a sudden and severe condition in which the heart is unable to pump blood efficiently to meet the body's demands. This results in a rapid accumulation of fluid in the lungs and/or other parts of the
body, leading to symptoms such as shortness of breath, fatigue, fluid retention, and swelling in the legs or abdomen.
Despite its high burden, there are paucity of data in study setting. Therefore, this study aimed to assess in-hospital
mortality and its associated factors among people with acute heart failure presented to emergency department at Hiwot
Fana Comprehensive Specialized Hospital, Harar Eastern Ethiopia.
Methods: An institution-based cross-sectional study with a retrospective chart review was conducted among 256
patients diagnosed with acute heart failure between January 2020 and January 2022. Data were retrieved and extracted
from April to May 2022. Data were extracted using a checklist, and analyzed using Statistical Package for Social
Science 23. Multivariable binary logistic regression was employed to identify factors associated with in-hospital mortality. Adjusted odds ratios with corresponding 95% confidence intervals were calculated to show the strength of the
associations. Factors with p-value < 0.05 were declared statistically significant.
Results: Of the 256 study participants, 64.9% (95% CI: 59.0%–70.7%) had acute decompensated heart failure, and
the majority (86.3%) were classified as New York Heart Association class IV. Major precipitating factors were identified in 70% of the cases, with pneumonia being the most common (53.1%). Comorbid conditions were present in
53.1% of the participants. In-hospital mortality was 13.6% (95% CI: 12.91% – 14.28%). Multivariable analysis
showed that initial triage scores >7 (AOR=3.25; 95% CI: 1.08-9.78), low diastolic blood pressure (AOR= 5.81; 95%
CI: 1.79 – 18.91), and low left ventricular ejection fraction (AOR= 3.53; 95% CI: 1.31 – 9.53) were factors associated
with in-hospital mortality.
Conclusion: This study highlights the significant concern of in-hospital mortality of acute heart failure. It further
reveals that acute decompensated heart failure accounts for the majority of acute heart failure cases, with pneumonia
emerging as the leading precipitating factor. Key associated factors of in-hospital mortality include a high initial triage
score, low diastolic blood pressure, and reduced left ventricular ejection fraction. Enhanced monitoring and tailored
care plans for patients with low diastolic blood pressure or reduced ejection fraction should be in place to prevent
deterioration.
Keywords: Acute Heart Failure, Clinical profiles, Emergency Medicine Department, Hiwot Fana Comprehensive Specialized Hospital, In-hospital Mortality