In-hospital mortality and predictors among hospitalized adults with acute heart failure in Southern Ethiopia: retrospective cohort study

Abstract

BACKGROUND: Acute heart failure is a leading cause of hospital admissions and mortality in Africa. Data on in-hospital outcomes and predictors of mortality remain limited in southern Ethiopia. Understanding these factors is crucial for improving patient management and resource allocation. OBJECTIVE: To determine the in-hospital mortality rate and identify factors associated with death among adults admitted with acute heart failure at Hawassa University Comprehensive Specialized Hospital. METHODS: We conducted a retrospective cohort study including 480 adult patients hospitalized with acute heart failure between September 2021 and September 2023. Clinical, laboratory, and treatment data were extracted from medical records using standardized definitions. Multivariate logistic regression was used to identify independent predictors of in-hospital mortality, expressed as adjusted odds ratios (AOR) with 95% confidence intervals (CI). RESULTS: The median age of patients was 67 years, and 51% were female. In-hospital mortality was 17%, with most deaths occurring early during hospitalization (median time to death: 4 days; IQR: 2-5). Rheumatic heart disease (31%), cardiomyopathy (20%), and ischemic heart disease (15%) were the most common underlying etiologies. Heart failure with preserved ejection fraction occurred in 64% of patients, whereas reduced ejection fraction was more common among those with cardiomyopathy or ischemic heart disease. Independent predictors of in-hospital death were acute kidney injury (AOR 8.9, 95% CI 4.2-18.8), mechanical ventilator support (AOR 4.4, 95% CI 2.3-8.5), and cardiogenic shock (AOR 2.2, 95% CI 1.4-3.4). CONCLUSION: In-hospital mortality was high, with most deaths occurring early during admission. Acute kidney injury, cardiogenic shock, and mechanical ventilatory support were strong independent predictors of mortality. These findings support close monitoring and timely management of high-risk patients during hospitalization.