Prognosis of hospitalized new-onset systolic heart failure in Indo-Asians--a lethal problem

Fahim H. Jafary, Aga Khan University
Mahesh Kumar, Aga Khan University
Irfan E. Chandna, Aga Khan University


Background: Systolic heart failure (SHF), particularly when requiring hospital admission carries a poor prognosis. There is a paucity of data in Indo-Asians on outcomes of SHF, among whom the burden of cardiovascular disease is consistently rising. The purpose of this study was to determine the frequency and predictors of mortality and morbidity amongst patients admitted with new-onset SHF at a tertiary care hospital in Pakistan.METHODS AND Results: Hospital charts of 196 patients with a diagnosis of new or recent onset (<3 >months) SHF (ejection fraction [EF] <40%) were reviewed. Patients who died during the admission, those with life-limiting concomitant disease, and those without follow-up were excluded. Survival was calculated according to the Kaplan-Meier method. Hazards ratios (HR) and 95% confidence intervals (CI) were calculated using Cox's regression model. Mean age (SD) was 61 (12.8) years. Majority (77%) had a prior ischemic heart disease. Mean EF (SD) was 25% (8.7). Median follow-up period was 379 days. Fifty-four (27.5%) patients died (at least 12 [22.2%] sudden deaths) and 102 (52%) experienced combined event of death or repeat hospitalization for SHF. Factors independently associated with death included (HR [95% CI]), serum sodium (0.94 [0.90-0.97]), admission pulse (1.02 [1.01-1.04]), systolic blood pressure (0.98 [0.97-0.99]), and severe mitral regurgitation (1.90 [1.03-3.48]).CONCLUSIONS: Admission for new or recent onset SHF predicts a grave 1-year prognosis in Indo-Asians. Measures to prevent ischemic heart disease and its sequelae are essential because developing nations simply cannot afford to treat and manage heart failure.