Abstract
Background:
Heart failure (HF) is a significant public health problem worldwide and is a leading cause of hospitalization and death. Acute heart failure (AHF), acute decompensated heart failure and de novo presentations are associated with significant morbidity, frequent hospital admission and poor clinical outcomes in spite of advances in therapeutic strategies. While large international registries have offered useful information about the epidemiology and outcome of AHF, information from the Middle East, particularly that of the United Arab Emirates (UAE), is limited. Understanding regional patterns of disease presentation, risk factors, and predictors of mortality is critical to improving the management of patients and planning of healthcare resources.
Objectives:
This systematic review and meta-analysis aimed to assess the clinical characteristics, outcomes and predictors of in-hospital mortality in patients admitted with acute heart failure in the United Arab Emirates and the Middle Eastern region.
Methods:
A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Electronic databases were searched for observational studies and registry-based cohorts that reported clinical characteristics and outcomes of patients admitted with acute heart failure in the Middle East. Studies that reported in-hospital mortality were included in the quantitative synthesis. Data extracted included study characteristics, sample size, demographic variables, comorbidities, and left ventricular ejection fraction and in-hospital mortality. Heterogeneity between studies was determined by using the I2 statistic. A total of five core studies with 7906 patients were included in the primary quantitative synthesis, with two additional studies considered to be included for narrative comparison.
Results:
Five studies that included 7,906 patients admitted with acute heart failure were included in the primary quantitative synthesis. The mean age of patients was between 59-66 years, and the majority of the patients were male (52.5-69.6%). Hypertension and diabetes mellitus are the most common comorbidities among all included cohorts whereas ischemic heart disease was commonly reported as a primary cause of heart failure. Reduced left ventricular ejection fraction was most prevalent in most study populations. In-hospital reported mortality in the five studies also varied between 5.0% and 10.4%. From the aggregated data, the crude weighted estimate of in-hospital mortality was about 6.50 %. Several clinical factors were linked to higher risk of mortality including advanced age, renal dysfunction, elevated natriuretic peptide levels, decreased ejection fraction and cardiogenic shock.
Conclusion:
Patients admitted with acute heart failure to hospital in the Middle East exhibit significant in-hospital mortality, with pooled estimates close to 6.50%. Hypertension, diabetes and ischemic heart disease have been found to be very common in affected patients and are indicative of the cardiovascular risk factors in the region. Identification of key risk determinants of mortality may provide for earlier risk stratification and better management strategies. Further large scale multicenter studies with a specific focus on the United Arab Emirates are warranted to help better define regional outcomes and optimize care for this high-risk population.