European Journal of Cardiovascular Medicine

Heart failure (HF) remains a major global health problem worldwide and is one of the main common causes of hospital admission among patients with cardiovascular disease. Acute congestive heart failure (ACHF) represents a serious clinical condition that is characterized by the rapid onset or worsening of symptoms such as dyspnea, fatigue, and fluid retention. Despite improvements in these diagnostic methods and treatment strategies, patients admitted with acute heart failure continue to experience considerable morbidity and mortality. (1)

Coronary artery disease (CAD) is widely recognized as one of the leading causes of heart failure. Myocardial ischemia and infarction can result in irreversible myocardial damage, which leads to impaired ventricular function and progressive cardiac remodelling. Over time, these structural and functional changes that occurred in the myocardium may lead to the development of symptomatic heart failure. Several epidemiological studies have reported that a significant proportion or association of patients who survive an acute myocardial infarction eventually develop heart failure during follow-up. (2)

The presence of coronary artery disease has also shown to influence the clinical course and prognosis of patients with heart failure. Patients with ischemic heart disease often have more severe myocardial injury and may experience higher rates of hospital admissions and mortality compared to those without CAD. In this prospective study conducted among the patients presenting with acute congestive heart failure, Purek et al reported that coronary artery disease was present in a large proportion of patients and was associated with significantly worse survival outcomes. Their findings suggested that the CAD is an important predictor of mortality in patients with acute heart failure.(3)

However, recent studies have highlighted the strong association between ischemic heart disease and poor outcomes in patients with HF. Patients who develop HF after myocardial infarction remain at increased risk of recurrent hospital admission and long-term cardiovascular complications despite advances in modern treatment. (4) Ischemic myocardial injury can also lead to structural changes in the heart, including ventricular dilation, fibrosis, and progressive decline in cardiac function. These processes, collectively known as cardiac remodelling, contribute significantly to the progression of heart failure (5). Considering the high prevalence of coronary artery disease in patients presenting with acute heart failure, understanding its impact on prognosis is essential.

Therefore, the present study aims to evaluate the prognostic significance of coronary artery disease in patients with acute congestive heart failure.

This hospital-based observational study was conducted in the Outpatient Department (OPD) and Inpatient Department (IPD) of RKDF Medical College Hospital and Research Centre, Bhopal. The study included a total of 104 patients diagnosed with acute congestive heart failure. Adult patients aged 18 years and older who were admitted with a diagnosis of acute congestive heart failure and provided informed consent were enrolled in the study. Patients with incomplete clinical records, those with severe non-cardiac comorbid conditions that significantly affect prognosis, and patients who refused to participate were excluded. Demographic and clinical data were collected from patient records and hospital databases. Information on age, sex, clinical presentation, comorbid conditions, laboratory tests, and imaging findings was documented. The presence of coronary artery disease was based on any of the following: documented history of myocardial infarction, prior percutaneous coronary intervention or coronary artery bypass graft surgery, angiographic evidence of significant coronary artery stenosis, or diagnosis confirmed by a cardiologist. Patients were categorized into two groups: those with coronary artery disease (CAD group) and those without coronary artery disease (Non CAD group). The primary outcome measures were hospital mortality, length of hospital stay,and clinical complications during hospitalisation. Secondary outcomes included rehospitalization rates and mortality within one year. All data were entered into Microsoft Excel and analyzed with suitable statistical software. Group comparisons employed the independent t-test for continuous variables and the chi-square test for categorical variables. Cox proportional hazards regression was utilised to determine independent predictors of mortality. A p-value below 0.05 was deemed statistically significant.

Table 1. Baseline Demographic and Clinical Characteristics

This study included 104 patients with ACHF, of whom 70 (67.3%) had CAD and 34 (32.7%) did not. Patients with CAD were marginally older than those without, though the difference was not statistically significant. Hypertension and diabetes mellitus were significantly more prevalent in the CAD group, whereas smoking history showed no significant variation. (Table 1).

Table 2. Clinical and Laboratory Findings at Admission.

At admission, heart rate and systolic blood pressure were similar between both groups. CAD patients, however, showed notably lower haemoglobin levels and higher BNP and troponin I levels, signalling increased cardiac stress and myocardial damage. While they also had a lower left ventricular ejection fraction, this difference was not statistically significant. (Table 2).

Table 3. In-Hospital Outcomes.

Patients with CAD were hospitalised more often and experienced longer stays. Although the CAD group showed higher rates of ICU admission and 30-day mortality, these differences did not reach statistical significance (Table 3).

Table 4. Treatment and Interventions.

Nitrates and antiplatelet therapy were significantly more common among CAD patients, whereas the use of ACE inhibitors, beta blockers, and diuretics was comparable across groups (Table 4).

Table 5. One-Year Clinical Outcomes.

Rehospitalization within one year was more common among CAD patients and nearly reached statistical significance. Mortality was also higher in this group, and the average survival time was shorter compared to patients without CAD (Table 5).

Table 6. Predictors of Mortality (Cox Regression Analysis).

Coronary artery disease was identified as an independent predictor of mortality. Additionally, being over 65 years old and having elevated BNP levels were significantly linked to a higher risk of death (Table 6).

The current study assessed the prognostic importance of coronary artery disease (CAD) in patients admitted with acute congestive heart failure. It found that CAD was common and linked to worse clinical outcomes. These findings align with recent epidemiological data showing that CAD continues to be a major cause of cardiovascular illness and death worldwide. Recent global estimates highlight the significant and growing burden of coronary artery disease and its key role in adverse cardiac events (6). Similar population studies have confirmed the persistent high prevalence and demographic differences in CAD among adults (7).

In terms of baseline characteristics (Table 1), patients with CAD were substantially more likely to have diabetes mellitus and hypertension. These results support the established role of vascular and metabolic risk factors in the development of atherosclerotic disease. According to earlier research, ischemic aetiology in heart failure patients is closely associated with traditional cardiovascular risk factors (8). Previous cohort studies evaluating heart failure following myocardial infarction also reported similar findings (2,3). However, the distribution of risk factors may be impacted by demographic and ethnic differences, according to certain regional registries (7).

Significantly lower haemoglobin and higher BNP and troponin I levels were found in CAD patients' laboratory profiles at admission (Table 2), indicating increased myocardial stress and damage. These findings are consistent with mechanistic and imaging research showing that ventricular remodelling and functional decline are accelerated by ischemic myocardial damage (5). It is well known that elevated levels of troponin and natriuretic peptide indicate the severity of the condition and a poor prognosis in heart failure (9,10). On the other hand, less prominent biomarker variation etiological subgroups have been reported by some observational registries (4).

In terms of in-hospital outcomes, CAD patients had more frequent admissions and longer hospital stays (Table 3), suggesting a more severe clinical course. Studies demonstrating that ischemic heart disease is linked to worse short-term outcomes and a higher hospitalization burden have reported similar results (1).

Additionally, Purek et al.studied that in patients with acute heart failure, CAD predicted worse in-hospital outcomes (3). Conversely, it has been shown that early revascularization techniques and improved perioperative care can reduce early mortality in specific populations(11,12).

Consistent with guideline-directed management, treatment patterns (Table 4) indicate that nitrates and antiplatelet therapy are more frequently used in CAD patients. Current recommendations emphasise antiplatelet therapy and anti-ischemic drugs as essential components of CAD treatment (13). Modern pharmacological approaches and optimized medical therapy have been associated with better survival and fewer cardiovascular events (8,14).

Long-term results (Table 5) showed that CAD patients had shorter survival times and greater rates of mortality and rehospitalization. Large observational studies that demonstrate the detrimental impact of ischemic etiology on the long-term prognosis of heart failure support these findings (4). Patients with significant ischemic burden also have higher long-term mortality, according to risk prediction models following coronary revascularization (15,16). However, new research indicates that regenerative therapies and sophisticated revascularization techniques may enhance long-term cardiac survival and function (17–19).

CAD was found to be an independent predictor of mortality, with a more than twofold increased risk of death, according to multivariable analysis (Table 6). This result is in line with earlier study showing that CAD is a significant predictor of the prognosis for heart failure (3). Further research has confirmed that patients with ischemic aetiology of heart failure have a lower survival rate (8,20). The strong correlation between ischemic burden and mortality is also supported by sophisticated surgical risk models (15).

Overall, the current study emphasizes how coronary artery disease significantly affects patients with acute congestive heart failure's short-term and long-term outcomes. To enhance risk stratification and clinical management in this high-risk population, early detection of CAD and the application of optimal therapeutic approaches are crucial.

The comparatively small sample size of this single-centre observational study may limit generalizability and preclude the establishment of causal relationships. To confirm these results and improve risk-stratification techniques, larger, multicenter prospective studies are required.

Coronary artery disease is prevalent in patients with acute congestive heart failure and is associated with worse in-hospital and long-term outcomes. These patients often experience longer hospital stays, increased rehospitalisation rates, and a higher risk of death. Moreover, CAD is an independent predictor of mortality. Early identification and proper management of CAD can potentially improve prognosis and clinical outcomes in this high-risk population.

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