The Epidemiology of Acute Decompensated Heart Failure in Emergency Settings

Abstract

Background: Acute decompensated heart failure (ADHF) is a leading cause of emergency department visits and hospital admissions worldwide and is associated with substantial morbidity, mortality, and resource utilization. Objective: To describe the epidemiological profile, clinical characteristics, and short-term outcomes of patients presenting with ADHF in an emergency department setting. Methods: This prospective observational study was conducted in the Emergency Department of Lady Reading Hospital, Peshawar, from September 2025 to December 2025 following ethical approval in August 2025. Adults presenting with clinically diagnosed ADHF were enrolled using consecutive sampling. Demographics, presenting features, comorbidities, heart failure subtype by ejection fraction where echocardiography was available, emergency disposition, and index-episode outcomes were recorded and analyzed using SPSS. Results: A total of 120 patients were included with mean age 63.4 ± 12.8 years; 60.0% were male. Acute dyspnea was the most frequent presenting symptom (90.0%), followed by orthopnea (70.0%) and peripheral edema (63.3%). Hypertension (71.7%) and ischemic heart disease (53.3%) were common comorbidities. Echocardiography was available in 85.0%; among these, 56.9% had reduced ejection fraction. Most patients required admission (78.3%). Mortality during ED stay was 6.7%, and overall short-term mortality during the index episode was 15.8%. Conclusion: ADHF imposes a substantial emergency-care burden with high admission needs and clinically important short-term mortality, supporting the need for strengthened emergency-based management pathways.