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Title: Development of Acute Decompensated Heart Failure Among Hospital Inpatients: Incidence, Causes and Outcomes.
Austin Authors: Plant, Luke D ;Taylor, David McD ;Worland, Thomas ;Puri, Arvind ;Ugoni, Antony;Patel, Sheila K ;Johnson, Douglas F;Burrell, Louise M 
Affiliation: Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Mar-2019 2017-12-23
Publication information: Heart, Lung & Circulation 2019; 28(3): 406-413
Abstract: We aimed to investigate the incidence, precipitants, and outcomes of acute decompensated heart failure (ADHF) that develops during the inpatient stay. We undertook a case-control study in the medical, oncology, surgical, and orthopaedic wards of a tertiary referral hospital (February-May, 2016). Patients aged ≥18 years who developed ADHF during their inpatient stay were enrolled as cases. One control patient was matched to each case by age, gender, presenting complaint/surgery performed and co-morbidities. Multivariate regression was employed to determine variables associated with ADHF. The incidence of ADHF was 1.0% of patients. Eighty cases were well-matched to 80 controls (p>0.05). ADHF precipitants comprised 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%). Three variables were associated with 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 >2000ml of IV fluid on the day before the ADHF (OR 8.3, 95%CI 1.5-48.0). The day before the ADHF, cases were administered significantly more IV fluids than controls (median 2,757.5 versus 975ml, p=0.001). Medication errors mostly related to failure to restart regular diuretics. Cases had significantly greater length of stay (median 15 versus 6 days, p<0.001) and mortality (12.5% versus 1.3%, p=0.01). New onset ADHF is common and a substantial proportion of cases are iatrogenic. Cases experience significantly increased length of hospital stay, morbidity, and mortality.
DOI: 10.1016/j.hlc.2017.12.004
ORCID: 0000-0002-8986-9997
PubMed URL: 29519692
Type: Journal Article
Subjects: Acute decompensated heart failure
Intravenous fluids
Appears in Collections:Journal articles

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