Table 1.
Comparison of baseline characteristics, treatment and outcomes between hospitals of patients admitted with acute heart failure
| Characteristics | Kolkata (India) | UHCW (UK) (n=842) |
P value (accounting for multiplicity, difference statistically significant if p<0.05/3) | |||
| AGH (private) (n=508) |
NRS (public) (n=302) |
NRS–AGH | UHCW–AGH | UHCW–NRS | ||
| Demographics and medical history | ||||||
| Age - years, mean (SD) | 65.9 (11.8) | 63.0 (12.7) | 77.0 (12.9) | 0.001 | <0.001 | <0.001 |
| Female, n (%) | 171 (34) | 106 (35) | 363 (43) | 0.677 | 0.001 | 0.015 |
| Number of comorbidities, n (%)* | ||||||
| ≤1 2–8 |
416 (81.9) 92 (18.1) |
159 (52.6) 143 (47.4) |
509 (60.5) 333 (39.5) |
<0.001 | <0.001 | <0.001 |
| IHD, n (%): | 328 (66.1) | 93 (31.0) | 367 (44.3) | <0.001 | <0.001 | <0.001 |
| Valve disease, n (%): | 33 (6.6) | 53 (17.5) | 163 (19.6) | <0.001 | <0.001 | 0.453 |
| Hypertension, n (%): | 340 (67.9) | 128 (42.7) | 349 (41.9) | <0.001 | <0.001 | 0.829 |
| Diabetes, n (%): | 289 (57.1) | 114 (37.7) | 282 (33.8) | <0.001 | <0.001 | 0.219 |
| COPD/asthma, n (%): | 77 (15.3) | 16 (5.3) | 52 (6.2) | <0.001 | <0.001 | 0.562 |
| CKD, n (%): | 108 (21.4) | 32 (10.6) | 256 (36.0) | <0.001 | <0.001 | <0.001 |
| Revascularisation (PCI/CABG), n (%): | 159 (31.9) | 33 (10.9) | 142 (19.9) | <0.001 | <0.001 | 0.001 |
| Rheumatic fever, n (%): | 7 (1.4) | 28 (9.5) | 0 (0) | <0.001 | 0.002 | <0.001 |
| LVEF - mean (SD) | 40.8 (10.9) | 43.1 (14.8) | N/A | 0.01 | N/A | N/A |
| Classification of HF n (%) | ||||||
| HF with reduced ejection fraction HF with preserved ejection fraction No inpatient echocardiography available |
388 (76.4) 115 (22.6) 5 (1) |
216 (71.5) 58 (19.2) 28 (9.3) |
480 (57) 275 (32.7) 87 (10.3) |
<0.002 | <0.001 | <0.001 |
| Clinical and laboratory characteristics on admission | ||||||
| Weight - kg, mean (SD) | ||||||
| On admission On discharge |
65.7 (10.8) 57.3 (21.6) |
62.2 (14.1) 51.2 (24.4) |
78.9 (21.2) 57.4 (38.2) |
0.015 0.018 |
<0.001 1 |
<0.001 0.01 |
| Breathlessness, n (%) | ||||||
| No limitation of physical activity Slight limitation Marked limitation Symptoms at rest |
0 (0) 37 (7.4) 84 (16.8) 380 (75.8) |
0 (0) 14 (4.7) 84 (27.9) 203 (67.4) |
28 (4.2) 72 (10.8) 443 (66.2) 126 (18.8) |
0.001 | <0.001 | <0.001 |
| Peripheral oedema, n (%): | ||||||
| No Mild Moderate Severe |
355 (71.0) 32 (6.4) 103 (20.6) 10 (2.0) |
88 (29.2) 105 (34.9) 84 (27.9) 24 (8.0) |
80 (13.7) 118 (20.2) 260 (44.6) 125 (21.4) |
<0.001 | <0.001 | <0.001 |
| Systolic blood pressure | ||||||
| Mean (SD) Median (IQR) |
144 (32.6) 140 (120–170) |
117 (31.2) 110 (90–140) |
132 (26.4) 130 (115–150) |
<0.001 | <0.001 | <0.001 |
| Heart rate: | 32–170 | 30–180 | 40–174 | |||
| Mean (SD) Median (IQR) |
98 (23.3) 96 (82–113) |
120 (24.7) 120 (110–132) |
84 (20.2) 80 (70–96) |
<0.001 | <0.001 | <0.001 |
| Clinical and organisational care | ||||||
| Disease-modifying drugs, n (%)† | ||||||
| ACEi/ARB only Beta-blocker only ACEi /ARB and beta-blocker ACEi/ARB, beta-blocker and MRA No ACEi/ARB, beta-blocker and MRA Contraindication to ACE inhibitor/ARB Loop diuretic and/or thiazide diuretic |
47 (9.3) 65 (12.8) 27 (5.3) 42 (8.3) 138 (27.2) 51 (10) 394 (77.6) |
5 (1.6) 33 (10.6) 13 (4.2) 39 (12.9) 29 (9.6) 32 (16.8) 279 (89.4) |
89 (10.6) 154 (18.3) 239 (28.4) 127 (15.1) 157 (18.6) 22 (2.6) 672 (79.8) |
<0.001 0.43 0.52 0.03 <0.001 0.8 <0.001 |
<0.44 0.007 <0.001 <0.001 <0.001 <0.001 0.33 |
<0.001 0.003 <0.001 0.36 <0.001 <0.001 <0.001 |
| Device therapy, n (%)‡ | ||||||
| None Cardiac re-synchronisation therapy Implantable cardioverter-defibrillator Permanent pacemaker |
437 (86.9) 16 (3.2) 9 (1.8) 41 (8.1) |
278 (97.5) 0 0 7 (2.5) |
755 (90.9) 43 (5.2) 4 (0.5) 29 (3.5) |
<0.001 | <0.001 | <0.001 |
| Main place of care, n (%) | ||||||
| CCU/ICU ward§ |
473 (93.1) 35 (6.9) |
171 (56.6) 131 (43.4) |
504 (60.6) 327 (39.4) |
<0.001 | <0.001 | 0.222 |
| Specialist, input n (%) | ||||||
| Cardiologist Specialist HF nurse Non-cardiologist |
448 (88.2) 0 (0) 60 (11.8) |
297 (99.3) 0 (0) 2 (0.7) |
493 (62.2) 125 (15.8) 175 (22.1) |
<0.001 | <0.001 | <0.001 |
| Patient outcomes | ||||||
| Death in hospital, n (%) | 38 (7.5) | 36 (11.9) | 67 (8.0) | 0.034 | 0.75 | 0.039 |
| Length of hospital stay - median (IQR) | 6 (4–10) | 8 (7–11) | 8.5 (4–15) | <0.001 | <0.001 | 0.947 |
*This refers to the comorbidities included in the registry only.
†Medications on discharge (this does not include other drug combinations such as mineralocortoid antagonist with beta-blockers or ACEi).
‡Device therapy on or prior to admission.
§This refers to both medical (including cardiology) and non-medical wards.
ACEi, ACE inhibitor; AGH, Apollo Gleneagles Hospital; ARB, angiotensin receptor blockade; CABG, coronary artery bypass grafting; CCU, coronary care unit; CKD, chronic kidney disease with estimated glomerular filtration rate below 60mL/min/1.73m2; COPD, chronic obstructive pulmonary disease; HF, heart failure; ICU, intensive care unit; IHD, ischaemic heart disease; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid receptor antagonist; NRS, Nil Ratan Sircar Hospital; PCI, percutaneous coronary intervention; UHCW, University Hospitals Coventry and Warwickshire.