Clinical profile and outcomes of heart failure patients in the emergency department with disposition for intensive care unit admission in a tertiary hospital in the Philippines
B Elvambuena, F E Punzalan, B P Maglinte, O K MacadatoAbstract
Background
Heart failure remains a major cause of mortality in the Philippines, with in-hospital mortality for acute heart failure in our hospital reaching 11.2%. This study describes the clinical profile and outcomes of heart failure patients in the Emergency Department with a disposition for Intensive Care Unit admission.
Methods
This retrospective cohort study included 122 adult heart failure patients given an Intensive Care Unit disposition at our institution from December 2022 to June 2024. Demographic data, clinical characteristics, and hospital outcomes were analyzed.
Results
Among 122 heart failure patients with disposition for ICU admission, the median age was 54 years (IQR 43-66), with 61.5% male. Most patients (83.6%) had reduced ejection fraction (<50%), and the majority presented with NYHA class III-IV symptoms (73.5%). Non-ischemic etiology predominated (78.7%). The median systolic blood pressure was 120 mmHg (IQR 100-148), heart rate 100 bpm (IQR 89-115), and creatinine 143 mmol/L (IQR 96-354). Infection was the most common precipitant of decompensation (53.3%), followed by dietary/fluid indiscretion and medication non-compliance (27.0% each). Despite disposition for ICU admission, only 18.9% were actually admitted to the ICU, with shock (40.2%) and need for intubation (28.4%) being the primary indications. Overall in-hospital mortality was 17.1%. Invasive mechanical ventilation was required in 43.7% of patients, non-invasive ventilation in 28.6%, and ACLS in 28.6%. The median hospital length of stay was 9 days (IQR 4-16). Hospital-acquired pneumonia occurred in 6.7% of patients.
Conclusion
Patients requiring intensive care for heart failure are relatively young and socioeconomically disadvantaged. Limited Intensive Care Unit access results in Emergency Department management of critically ill patients. Addressing infectious triggers and expanding critical care capacity may improve outcomes.