Precipitating Factors of Acute Heart Failure: A Cross-Sectional Observational Study from a Tertiary Care Hospital in Pakistan

Abstract

Objectives: To determine the frequency of precipitating factors for acute heart failure (AHF) admissions and to examine their associations with baseline demographic and clinical covariates in a tertiary care setting. Methodology: A cross-sectional observational study was conducted in the Department of Cardiology at Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan, from June 20, 2023, to December 20, 2023. Adult patients aged 30–75 years admitted with acute heart failure were enrolled using a non-probability purposive sampling technique. Clinically verifiable precipitating factors—including medication non-compliance, anemia, uncontrolled hypertension, myocardial ischemia, and arrhythmia—were systematically assessed using standardized operational definitions. Data were analyzed using SPSS version 26.0. Associations between precipitants and baseline variables were explored using chi-square or Fisher’s exact tests, followed by multivariable logistic regression analysis. Results: A total of 165 patients were included, with a mean age of 53.14 ± 10.49 years and a slight female predominance (50.3%). The average duration from symptom onset to hospital presentation was 7.72 ± 4.24 hours. The most frequently observed precipitating factor was medication non-compliance (58.18%), followed by anemia (49.69%), uncontrolled hypertension (45.5%), myocardial ischemia (45.45%), and arrhythmia (15.15%). Younger patients demonstrated higher rates of medication non-compliance and ischemia, while uncontrolled hypertension was more common in older individuals. Females exhibited significantly higher frequencies of arrhythmia, ischemia, and anemia (p = 0.02). In multivariable analysis, no baseline variable independently predicted any major precipitant (all p > 0.05). Conclusion: Medication non-compliance emerged as the most common precipitating factor for acute heart failure admissions. The absence of independent predictors in multivariable analysis highlights the multifactorial nature of acute heart failure decompensation, driven by overlapping clinical and behavioral determinants.