Clinical Characteristics, Management, and Length of Hospital Stay Between Patients with New-Onset and Acute Decompensated Chronic Heart Failure: A Prospective Cohort Study in Ethiopia

Figures & data

Table 1 Demographic Characteristics of Patients Admitted with Heart Failure with De novo and ADCHF

Variables	Total (n=228)	HF Category
		De novo HF(n=97)	ADCHF (n=131)	P-value
Age(years) mean±SD	53.31±15.68	51.84±14.94	54.31±16.60	0.222
Sex
Male n (%)	102(44.7)	49(48.0)	53(52.0%)	0.131
Female n (%)	126(55.3)	48(38.1)	78(61.9)
BMI (kg/m2)
<24.9 n (%)	147(64.5)	55(37.4)	92(62.6)	0.105
25–30 n (%)	55(24.1)	28(50.9)	27(49.1)
>30 n(%)	26(11.4)	14(53.8)	12(46.2)
Residency
Urban n (%)	108(47.4)	53(49.1)	55(50.9)	0.051
Rural n (%)	120(52.6)	44(37.5)	76(62.5)
Education level
No formal education n (%)	101(44.3)	38(37.6)	63(62.4)	0.186
Primary education n (%)	30(13.2)	10(33.3)	20(66.7)
Secondary education n (%)	40(17.5)	19(47.5)	21(52.5)
Tertiary education n (%)	57(25.0)	30(52.6)	27(47.4)
Current occupation
Governmental employer n (%)	69(30.3)	37(53.6)	32(46.4)	0.026
Non-government employer n (%)	159(69.7)	60(37.7)	99(62.3)
Excessive alcohol use
Yes n (%)	67(29.4)	28(41.8)	39(58.2)	0.882
No n (%)	161(70.6)	69(42.9)	92(52.1)
Salt restriction
Yes n (%)	127(55.7)	50(39.4)	77(60.6)	0.277
No n (%)	101(44.3)	47(46.5)	54(53.5)
Chewing chat n (%)
Never	182(79.8)	78(42.9)	104(57.1)
Sometimes	32(14.0)	15(46.9)	17(53.1)	0.504
Always	14(6.1)	4(28.6)	10(71.4)
Smoker n (%)
Never	179(78.5)	75(41.9)	104(58.1)
Ex-smoker	36(15.8)	16(44.4)	20(55.6)	0.926
Current smoker n (%)	13(5.7)	6(46.2)	7(53.8)
Physical activity n (%)
Active	79(34.6)	41(51.9)	38(48.1)
Inactive	149(65.4)	56(37.6)	93(62.4)	0.037
Drink coffee n (%)
Yes	138(60.5)	87(63.0)	51(37.0)	0.035
No	90(39.5)	46(51.1)	44(48.9)
Use traditional medicine n (%)				0.319
Yes	52 (22.8)	19(36.5)	33(63.5)
No	176(77.2)	78(44.3)	98(55.7)

Abbreviations: HF, heart failure; ADCHF, acute decompensated chronic heart failure; BMI, body mass index; SD, standard deviation.

Figure 1 Heart patient selection flow chart at Debre Markos Comprehensive specialized Hospital medical ward from November 01, 2019, to April 30, 2021.

Table 2 Clinical Characteristics of Patients Admitted with Heart Failure at DMCSH

Sign and Symptoms n (%)	Total (n = 228)	HF Category
		De Novo HF	ADCHF	P-value
Pulmonary congestion n (%)	67(29.4)	20(29.9)	47(70.1)	0.051
Peripheral congestion n (%)	127(55.7)	55(43.3)	72(56.7)	0.794
Cough n (%)	150(65.8)	63(42.0)	87(58.0)	0.818
Fatigue n (%)	145(63.6)	55(37.9)	90(62.1)	0.004
Dyspnea	152(66.7)	61(40.1)	91(59.9)	0.297
Orthopnea n (%)	134(58.8)	57(42.5)	77(57.5)	0.998
Raised JVP n (%)	45(19.7)	13(28.9)	32(71.1)	0.039
PND n(%)	80(35.1)	35(43.8)	45(56.2)	0.787
Gallop	32(14)	18(56.2)	14(43.8)	0.091
NYHA Class IV n (%)	212(93.0)	91(42.9)	121(57.1)	0.672
AHA/ACC stage C n (%)	220(96.5)	94(42.7)	126(57.3)	0.880
Ejection fraction
<50%	95(41.7)	51(53.7)	44(46.3)	0.004
≥50	133(58.3)	46(34.6)	87(65.4)
Vital signs
Heart rate (b.p.m) mean±SD	104.54±16.68	105.51±19.64	103.82±18.99	0.503
Respiratory rate (p.m) mean±SD	25.41±5.07	25.44±5.42	25.39±4.82	0.937
Temperature (C^0) mean±SD	37.01±0.78	37.15±0.76	36.92±0.78	0.026
SBP (mmHg) mean±SD	108.9±24.00	106.66±23.74	109.08±24.29	0.895
DBP(mmHg) mean±SD	67.60±13.55	67.18±13.92	67.91±13.31	0.687
Laboratory findings
Serum creatinine mean±SD	1.34±.73	1.33±0.72	1.34±0.72	0.943
Blood urea nitrogen mean±SD	19.02±6.6	18.57±6.46	19.35±6.71	0.380
Hemoglobin (g/dl) mean±SD	13.99±3.01	13.79±2.95	14.15±3.05	0.158
RBG/FBG(mg/dl) mean±SD	159.94±73.91	162.28±75.52	158.21±72.94	0.682
Sodium level (mEq/L mean±SD	134.97±10.12	135.92±9.55	134.26±10.50	0.220
Potassium level,(mEq/L) mean±SD	3.58±0.91	3.50±0.83	3.63±0.97	0.229
Co-morbidities
Ischemic heart disease n(%)	21(9.2)	12(57.1)	9(42.9)	0.171
Hypertension n(%)	84(36.8)	31(37.3)	52(62.7)	0.266
Arterial fibrillation n(%)	50(21.9)	26(74.3)	9(25.7)	0.040
Dyslipidemia n (%)	87(38.2)	27(31.0)	60(69.0)	0.006
Diabetes mellitus n(%)	77(33.7)	31(40.3)	46(59.7)	0.672
Infection n(%)	91(39.9)	50(54.9)	41(45.1)	0.133
Asthma/COPD n(%)	63(42.5)	26(41.3)	37(58.7)	0.004
Anemia n(%)	63(27.6)	29(46.0)	34(54.0)	0.409
Chronic renal failure n(%)	32(14)	15(46.9)	17(53.1)	0.700
Prior stroke n(%)	30(13.2)	6(20)	24(80)	0.009
Others^*	21(9.2)	8(38.1)	13(61.9)	0.818
Length of hospital stay (median, IQR)	12(8–18)	11(6–16)	13(9–20)	0.004

Note:

* Chronic liver disease, Thyroid disease, Deep venous thromboembolism.

Abbreviations: HF, heart failure; ADCHF, acute decompensated chronic heart failure; JVP, Jugular Venous Distention; SD, standard deviation; PND, Paroxysmal Nocturnal Dyspnea; NYHA, New York Health Association; AHA/ACC, American College of Cardiology/American Heart Association; b.p.m, beats per minutes; SBP, Systolic Blood Pressure; DBP, diastolic blood pressure; RBG/FBG, Random/fast blood glucose; COPD, chronic obstructive pulmonary disease; IQR, interquartile range.

Table 3 Admission and Discharged Medication for Hospitalized Heart Failure Patients

Medication During Hospitalization	Overall (N = 228)	HF Category
		De novo AHF	ADCHF	p.value
ACE inhibitors n (%)	86(37.7)	36(41.9)	50(58.1)	0.891
ARBs n (%)	65(28.5)	35(53.8%)	30(46.2)	0.032
Beta-blockers n (%)	61(26.8)	26(42.6)	35(57.4)	0.650
Diuretics n (%)	169(74.1)	64(37.9)	105(62.1)	0.021
Vasodilators n (%)	26(11.4)	9(34.6)	17(65.4)	0.409
Digoxin n (%)	95(41.7)	58(61.1)	37(38.9)	0.002
Anticoagulants n (%)	71(31.1)	28(39.4)	43(60.6)	0.565
Antiplatelet n (%)	69(30.3)	23(33.3)	46(66.7)	0.080
Inotropic agents n (%)	19(8.3)	7(26.8)	12(63.2)	0.638
Statins n (%)	73(32.0)	30(41.1)	43(58.9)	0.776
Medication during discharged
ACE inhibitors n (%)	97(42.5)	40(41.2)	57(58.8)	0.787
ARBs n (%)	52(22.8)	27(51.9)	25(48.1)	0.151
Beta-blockers n (%)	102(44.7)	41(40.2)	61(59.8)	0.030
Diuretics n (%)	147(64.5)	54(36.7)	93(63.3)	0.018
Vasodilators n (%)	10(4.4)	6(60.0)	(40.0)	0.747
Digoxin n (%)	56(24.7)	22(39.3)	34(60.7)	0.641
Anticoagulants n (%)	77(33.8)	32(42.1)	44(58.9)	0.925
Antiplatelet n (%)	95(41.7)	36(37.9)	59(62.1)	0.277
Statins n (%)	80(35.1)	30(41.1)	43(58.9)	0.779

Abbreviations: HF, heart failure; ADCHF, acute decompensated chronic heart failure; ACEIs, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor Blockers.

Table 4 Binary and Multivariate Logistic Regression Analysis to Identify Factors Associated Within Long-Term Hospital Stay Among Heart Failure Patients at DMCSH

Variables	COR (95% CI)	P-value	AOR (95% CI)	P-value
Systolic blood pressure(mmHg)	1.11(1.00–1.23)	0.057	1.26(0.99–1.53)	0.006
Serum creatinine (mg/dl	0.51(0.34–0.76)	0.001	0.46(0.27–0.87)	0.004
Heart failure category
ADCHF	2.03 (1.18–3.48)	0.010	2.66(1.35–5.22)	0.005
New onset (de novo) HF	1.00	1.00	1.00	1.00
Diabetes mellitus
Yes	2.40(1.13–5.11)	0.023	2.07(0.99–4.33)	0.025
No	1.00	1.00	1.00	1.00
Class of medication ARBs
Yes	1.69(0.95–3.00)	0.074	2.32(1.03–5.20)	0.042
No	1.00	1.00	1.00	1.00

Abbreviations: HF, heart failure; ADCHF, acute decompensated chronic heart failure; DMCSH, Debre Markos Comprehensive Specialized Hospital; ARBs, angiotensin receptor blockers; COR, crude odd ratio; AOR, adjusted odd ratio.