Estimated Glomerular Filtration Rate(eGFR) and Short Term Outcomes in Patients with Acute Decompensated Heart Failure(ADHF) Admitted in a Tertiary Care Centre In Kerala

Abstract

Background
Admission with acute decompensated heart failure(ADHF) is associated with excessive morbidity and mortality. Despite impressive advances in management of heart failure, ADHF remains one of the major health care problem worldwide. A significant component of heart failure (HF) related mortality occurs during hospital stay. Although there exist many long-term prognostic markers for heart failure (HF), there is a dearth of studies regarding predictors of short term outcomes. In this study, we aimed to determine whether eGFR can be used as a predictor of short-term outcomes in ADHF patients and to find other sensitive, affordable short term outcome predictors if any.
Objectives
1. To identify whether eGFR can be used as a predictor of short term outcomes in ADHF patients.
2. To study factors associated with high in hospital mortality in ADHF patients.
Methodology
A hospital based prospective observational study was conducted among 117 patients admitted with ADHF in Government T.D. Medical College Alappuzha. Samples were selected by convenient sampling method. After obtaining informed written consent data was collected using proforma and it was analysed using SPSS version 20.0. In this study patients were divided into two groups based
eGFR (calculated by MDRD formula from admission creatinine values). An eGFR ≥45ml/min/1.73m2 was considered high and eGFR < 45ml/min/1.73m2was considered low. Then short-term outcomes in both groups were compared. We also divided patients into two groups based on ejection fraction (EF). HFpEF was defined as having EF ≥45% and HFrEF as having EF<45%. Short term outcomes in these groups were also compared.
Result
Majority of study population was elderly with female preponderance (55.6%). Majority of the cases  were readmissions for acute decompensation of HF with most common precipitating factor being ischemia (41%), drug default (16%) and volume overload (15.4%). 34.2% had high eGFR and 65.8% had low eGFR. 41% patients had HFrEF and 59% had HFpEF. In 61.4% patients who were readmitted
with heart failure, GDMT was prescribed for 37%. Only 51.9% patients were adherent to medications. Study population were treated with antiplatelets (100%), diuretics (82.1%), statins (76.9%), ACEI (41%), ARB (35.9%), MRA (35.9%), beta blocker (30.8%), vasodilator (15.4%)and SGLT2i(8%). None was treated with ARNI, ivabradine, digoxin. Low eGFR was associated with poor short term outcomes as measured by development of hypotension, arrhythmia, need for inotropic support, NIV, invasive ventilation, dialysis support, ICU admission, duration of ICU stay, duration of hospital stay and mortality. Other factors associated with poor short term outcomes are HFrEF, comorbidities like CAD, DM and HTN. Noncompliance to GDMT, higher NYHA FC, readmission, ischemia, LVDD and comorbidities like CAD,DM,HTN are associated with higher in hospital mortality.
Conclusion
Low eGFR and HFrEF was associated with poor short term outcomes as measured by development of complications, requirement of ionotope, ventilator and dialysis support and mortality. There is a strong association between noncompliance to GDMT, higher NYHA FC, readmission, ischemia, LVDD, CAD,DM and HTN with higher in hospital mortality in ADHF.