Investigation of factors impacting the prognosis of patients diagnosed with heart failure presenting to the emergency department due to dyspnea

Aim: Acute heart failure (AHF) is a significant public health concern worldwide, particularly being a primary cause of hospitalization and mortality in the elderly population. The management of patients presenting to the emergency department with AHF is intricate, and assessing prognosis and determining appropriate treatment strategies are crucial. Our study aims to address the importance of prognosis assessment in patients with AHF presenting to the emergency department, utilizing a comprehensive approach involving medical history, physical examination, electrocardiography (ECG), laboratory investigations, imaging findings, and risk stratification. Materials and Methods: This study is a prospective, single-center cohort investigation conducted to explore the prognostic assessment of clinical parameters in patients with acute heart failure (AHF) presenting to the emergency department. The study encompasses 247 patients aged 18 and above who presented with complaints of dyspnea and were diagnosed with heart failure. Within the scope of the study, demographic information, vital signs, physical examinations, electrocardiogram (ECG) findings, blood gas results, laboratory findings, imaging findings, and scoring systems were recorded for the patients. Vital signs, blood gas, and laboratory parameters were assessed by categorizing them. The primary endpoint was defined as the occurrence of invasive mechanical ventilation, vasopressor drug use, hemodialysis, coronary angiography, electrical cardioversion, and the development of cardiac arrest in the emergency department. The composite of any of these events was termed as the total primary endpoint (TPS). The secondary endpoint was defined as in-hospital mortality. Additionally, the risk status of patients was evaluated in the study using the ADHERE, EHMRG, and GWTG scoring systems. Results: The mean age of patients in our study was found to be 75.6±10.892 years. Of the patients included in the study, 54.7% were female (n=135), and 45.3% were male (n=112). In 28.7% of the 247 patients participating in the study (n=71), at least one primary endpoint occurred. Hospital mortality was observed in 15.8% of the 247 patients included in our study (n=43). Statistically significant differences were observed in TPS development and non-development groups for ADHERE (p<0.001), EHMRG (p=0.002), and GWTG (p=0.016) scores in our study. 4 Parameters that were found to be significant in Cox regression analysis were included in the model analysis to assess the risk of TPS development. According to this model, having a high risk in ADHERE scoring increased the risk of TPS development by 1.6 times, the presence of orthopnea increased the risk of TPS development by 2 times, lactate levels above 2 increased the risk of TPS development by 2 times, AST levels above 50 U/L increased the risk of TPS development by 1.9 times, diastolic blood pressure below 60 mmHg increased the risk of TPS development by 3 times, and the presence of pleural effusion on radiology increased the risk of TPS development by 2.3 times. Parameters found to be significant in Cox regression analysis were included in the model analysis to assess the risk of in-hospital mortality. According to this model, being in the high-risk group in GWTG scoring increased the risk of in-hospital mortality by 10.6 times, the presence of dyspnea increased the risk of in-hospital mortality by 2 times, lactate levels above 2 increased the risk of in-hospital mortality by 2.5 times, AST levels above 50 U/L increased the risk of in-hospital mortality by 3.5 times, a history of SVO increased the risk of in-hospital mortality by 5.2 times, a history of liver disease increased the risk of in-hospital mortality by 24.4 times, and a history of malignancy increased the risk of in-hospital mortality by 2.6 times. Conclusion: In our study, we comprehensively examined factors influencing clinical deterioration and mortality in patients presenting to the emergency department with dyspnea and diagnosed with acute heart failure (AHF). By evaluating various parameters such as vital signs, blood gas parameters, laboratory values, and clinical risk scoring systems, we developed new risk models that incorporate specific additional parameters into existing scores for use in emergency departments in our country. This study provides emergency department physicians with an analytical approach to predict patient prognosis, determine critical treatment options, and anticipate future risks, thereby facilitating more effective clinical assessment and treatment planning.