Plant LD, et al. - In the pursuit of the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) that develops during the inpatient stay, this investigation was planned. A common incidence of new-onset ADHF, with iatrogenic etiology in a substantial proportion of cases, was reported. Also, significantly increased length of hospital stay, morbidity, and mortality was observed.

Methods

• Patients aged ≥18 years who developed ADHF during their inpatient stay were included in this case-control study as cases and this investigation was carried out in the medical, oncology, surgical, and orthopaedic wards of a tertiary referral hospital (February–May, 2016).
• One control patient was matched to each case by age, gender, presenting complaint/surgery performed and co-morbidities.
• Variables associated with ADHF were identified using multivariate regression.

Results

• Data reported that the incidence of ADHF was 1.0% of patients and 80 cases were well-matched to 80 controls (p > 0.05).
• Infection (30%), inappropriate intravenous (IV) fluid and medication management (23.8% and 8.8%, respectively), tachyarrhythmia (12.5%), ischaemic heart disease (8.8%), renal failure (1.3%), and other/unclear causes (15%) were identified as ADHF precipitants.
• The following 3 variables were found to be related to ADHF: not having English as the preferred language (OR 3.5, 95%CI 1.2–9.8), a history of ischaemic heart disease (OR 3.3, 95%CI 1.2–9.1), and the administration of >2000 ml of IV fluid on the day before the ADHF (OR 8.3, 95%CI 1.5–48.0).
• In addition, findings demonstrated that cases vs controls were administered significantly more IV fluids the day before the ADHF (median 2,757.5 vs 975 ml, p=0.001).
• Researchers found that medication errors mostly related to failure to restart regular diuretics.
• Significantly greater length of stay (median 15 vs 6 days, p < 0.001) and mortality (12.5% vs 1.3%, p=0.01) were reported in cases.