Clinical Characteristics and Outcomes of Patients with Acute Decompensated Heart Failure in Al-Hussein Teaching Hospital in Al-Samawa, Iraq (2021-2022)

Background: Acute Decompensated Heart Failure (ADHF) leads to millions of hospitalizations every year and has an enormous burden of morbidity and mortality around the globe. The clinical profile/compliance of a patient with ADHF will vary greatly based upon a number of different factors such as geography, genetics, and the availability of health care resources. Unfortunately, data from secondary and tertiary care in the southern region of Iraq, specifically within the Al-Muthanna Governorate, are limited, but critical to help enhance local management strategies and allocate resources more efficiently. Purpose: The primary aim of this study was to characterize the clinical characteristics, management in the hospital, and outcomes of patients residing in Al-Samawa, Iraq, with a primary diagnosis of ADHF during the one-year period between April 1, 2021 and March 31, 2022. Methods: A prospective, observational cohort study involving adult patients (≥18 years of age) who were diagnosed with primary ADHF (per Framingham diagnostic criteria) was conducted in the cardiology ward and coronary care unit (CCU) of Al-Hussein Teaching Hospital, Al-Samawa, Iraq, over the one- year period. The details collected encompassed demographic variables, clinical presentation, precipitating event(s), ejection fraction (EF) status, laboratory data, and hospital management (i.e., therapies that were used to treat the patient in the hospital). In this study, the primary outcome was in- hospital mortality, and the secondary outcomes included length of stay and readmission rate within 30 days. Results: The mean age of patients who were studied was 64.2 ± 11.8 years, with 53.5% being male. The two most common comorbidities of patients admitted with ADHF were hypertension (65.1%) and coronary artery disease (51.2%). The most frequent precipitating factor for ADHF in this population was non-compliance with medications (44.2%). The cause of heart failure associated with 58.6% of the patients was heart failure with reduced ejection fraction (HFrEF). The overall mortality of the sample was found to be 7.9% (17/215). The mean length of hospital stay was 6.8 ± 3.9 days (median: 6 days). Among the patients who were discharged alive, 16.7% were readmitted within 30 days of discharge. The three main predictors of in- hospital mortality for this study population were hyponatremia, elevated admission serum creatinine level, and need for inotropic support. Conclusions: Patients admitted to Al-Samawa because of ADHF typically exhibit a significant percentage of hypertension and CAD, with non-adherence to medications being one of the major contributing preventable factors. The in-hospital mortality and 30-day readmission rates were relatively high, reflective of a substantial burden of disease. This emphasizes the need for additional resources aimed at patient education, medication adherence, and optimization of guideline-directed medical therapies to potentially improve outcomes for these patients in Southern Iraq.