Understanding Mortality in Acute Heart Failure: A Retrospective Study in Santiago, Chile

Backround: Acute heart failure (AHF) is a severe condition with high mortality, with variable data depending on the region. The objective of the study was to describe its mortality in a high-complexity hospital in Santiago, Chile, and the associated factors. Methods: A retrospective study was conducted with 184 patients admitted between 2017 and 2019, aged over 18, and diagnosed with AHF by a cardiology resident. Clinical, sociodemographic, and therapeutic variables were recorded. Regression models and descriptive statistics were used. Results: The 12-month mortality rate was 22.7%, of which 35% were due to cardiac causes. The associated risk factors were age (HR 2.28, 95%CI: 1.22-4.23; p<0.05), plasma creatinine at admission (OR 1.87, 95%CI: 1.16-3.40; p<0.05), ProBNP over 4140 pg/mL (RR 2.0, 95%CI: 1.02-4.13; p<0.05), chronic kidney disease (OR 5.44, 95%CI: 1.5-9.3; p<0.05), and atrial fibrillation or flutter (OR 2.74, 95%CI: 1.30-5.76; p<0.05). The use of angiotensin-converting enzyme inhibitors (ACEi) and beta-blockers (BB) at discharge were protective for mortality (OR 0.45, 95%CI: 0.21-0.94; p<0.05 and OR 0.27, 95%CI: 0.09-0.79; p<0.05, respectively), as was a ProBNP level below 3220 pg/mL (RR 0.54, 95%CI: 0.28-0.96; p<0.05). Conclusions: AHF is associated with high one-year mortality in Chile, with significant relevance of patient history and admission tests. The use of ACEi and BB at discharge was associated with improved survival, highlighting the importance of optimized management during hospitalization and at discharge to improve prognosis.