Vol 41 # 3 September 2009 - Kma.org.kw

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KUWAIT MEDICAL JOURNAL September 2009
Original Article
Clinical Characteristics and Outcome of Acute Decompensated
Heart Failure (ADHF) Patients in Adan Hospital, Kuwait
Mustafa Ridha, Ihab Hamdy, Amin AlSayed, Boby Cherian, Sathyan H Cherian
Department of Internal Medicine, Cardiac Unit, Adan Hospital, Ministry of Health, Kuwait
Kuwait Medical Journal 2009; 41 (3): 222-225
ABSTRACT
Objectives: To determine the prevalence of acute
decompensated heart failure (ADHF) among the acute
medical admissions in Adan Hospital, Kuwait, and describe
their clinical characteristics and in-hospital mortality
Design: Prospective study
Setting: Medical wards and coronary care unit at Adan
Hospital, Kuwait
Subjects: All adult patients admitted from 18 th of September
to 17 th of November 2008 with the diagnosis of ADHF
Intervention: Echocardiography
Main Outcome Measures: Determination of the prevalence of
ADHF among medical admissions, their clinical features, and
their in-hospital mortality.
Results: The prevalence of ADHF was 14.5%. The mean
age of our patients was 60.3 ± 13.2 years. There was a male
preponderance (71.8 Vs 28.2%). There was a high percentage
of co-morbidities among our patients. The average length of
stay was 8.5 days. The in-hospital mortality was 4.9%. Betablocker
use was relatively less than other studies. 88.5%
patients had echocardiography done and 47.3% of them had
preserved left ventricular ejection fraction (LVEF > 45%).
Conclusion: The clinical profile of this sample of ADHF
reported from Kuwait is different from that observed in other
clinical studies. These findings might have implications in the
need for a nationwide database for future investigation and
comparison.
KEY WORDS: acute decompensation, heart failure, prevalence
INTRODUCTION
Acute heart failure is defined as the rapid onset
of signs and symptoms secondary to abnormal
cardiac function. It may occur with or without
previous cardiac disease. The cardiac dysfunction
can be related to systolic or diastolic dysfunction,
to abnormalities in cardiac rhythm, or to preload
and afterload mismatch [1,2] . The patients with acute
heart failure may present with one of several distinct
clinical conditions as acute decompensated heart
failure (ADHF) (either de-novo or as decompensation
of chronic heart failure), hypertensive heart failure,
severe pulmonary edema, cardiogenic shock, highoutput
heart failure, or right sided heart failure [2] .
Heart failure is one of the most important causes
of mortality and morbidity in the industrialized
world [3] . The prevalence of symptomatic heart
failure is estimated to range from 0.4 - 2% in the
general European population [4] .
Very limited information is available on the
characteristics and outcomes of ADHF patients in
Kuwait. The aim of the present study was to identify
the magnitude of the problem and to clarify the
clinical features and the care given to this category
of patients and to study their in-hospital outcome
at Adan Hospital, Kuwait during two consecutive
months.
PATIENTS AND METHODS
The study population consisted of patients in
whom the diagnosis of ADHF was made by the
patient’s medical team, and who were admitted
through the emergency department at Adan hospital
to either the coronary care unit (CCU), or directly
to the medical ward in the period from September
18 to November 17 of 2008. The final diagnosis
of ADHF was based on the criteria derived from
the executive summary of the guidelines on the
diagnosis and treatment of acute heart failure - The
Task Force on Acute Heart Failure of the European
Society of Cardiology [2] .
The clinical features, hospital course, and
echocardiographic findings were described and
compared. Standard echocardiographic techniques
were used by an experienced cardiologist and the left
ventricular ejection fraction (LVEF) was recorded.
Preserved LVEF was defined as those patients
with LVEF > 45% by M–Mode echocardiography
Address correspondence to:
Dr Mustafa Ridha, Department of Internal Medicine, Cardiac Unit, Adan Hospital, Ministry of Health, Kuwait. ridha3@hotmail.com