Heart Failure Outcomes in Patients with and without Renal Impairment

Aims: To evaluate the differences in clinical characteristics, management patterns and outcomes in acute heart failure patients with and without renal impairment.

Study Design: Prospective observational study.

Place and Duration of the Study: Department of Cardiology, Princess Esra Hospital, Telangana, Hyderabad, from August 2019 to January 2021.

Methods: We included 127 acute heart failure patients who were divided into two groups based on their renal function: group I having GFR >60ml/min (normal renal function) and group II having GFR ≤60ml/min (renal impairment). Subjective data, objective parameters and management patterns of patients were recorded during the hospital stay and the outcomes (improvement in NYHA class, readmissions and mortality) were assessed at follow up.

Results: Among a total of 127 patients; 62 patients had a LVEF <40% (HFrEF), 38 patients had a LVEF 40-49% (HFmEF) and 27 patients had a LVEF ≥50% (HFpEF).The prevalence of renal impairment was found to be more in acute heart failure patients with preserved EF (77.7%). Patients in group II were less likely to receive ACEIs/ARBs (P=0.0010) and digoxin (P=0.001) and more likely to receive H+ISDN (P=0.0001).The mortality in group II patients was significantly more when compared to group I patients at the end of 1 year follow up (41.46% vs 13.33%; P=0.001). Group ll also showed less clinical improvement in NYHA class (32.92% vs 46.66%; P=0.12) at the end of 1 year follow up.

Conclusion: AHF patients with renal impairment had higher mortality at one year. In this study glomerular filtration rate was a stronger predictor of mortality than left ventricular ejection fraction. There was significant underutilization of important heart failure therapies in patients with renal impairment. Future clinical trials are suggested to validate benefits of disease modifying therapies (H+ISDN) and newer drugs (ARNIs, SGLT2 inhibitors) in patients with renal impairment.