Heart Failure Patient Profiles, Management and Outcome: Results from a Heart Failure Clinic Registry

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The prevalence of heart failure has increased from 43.4 to 46.5% in the last 10 years in lower and middle-income countries like Bangladesh. This study aims to describe baseline clinical profiles, management strategies, and the in-hospital outcome of patients visited hospital for HF. Methods: A retrospective observational study was conducted on HF patients at a tertiary care hospital in Bangladesh. Relevant data were collected from patients’ medical records. Results: A total of 1536 patients with HF were included in our study. Of those, most were male (84%) and older than 55 years (62%) (mean (±SD) 53.2±6.5 years). A significant improvement was observed in the patients' functional status as defined by The New York Heart Association (NYHA) class. A total of 35 patients had a history of heart block, and 94% of them had first-degree blocks. Nearly two-thirds of patients (73%) had a history of heart failure with reduced ejection fraction (HFrEF). A significant change was observed in the patients' 6-minute walk test. Most common comorbid conditions were associated coronary artery disease (59%) followed by renal failure (17%). Hypertension (67%) and diabetes (55%) were the most common coronary risk factors. 1246 patients (81%) were diagnosed as ischemic patients. Beta blocker (88%), diuretic (72%), SGLT2 inhibitors (63%), and ARNI (49%) were most common medication. Overall, 78 patients received device where 54 patients (66%) used ACID and 28 (34%) used CRTD. A total of 226 patients died, 72% from cardiovascular and 28% from non-cardiovascular causes. Conclusions: There was a high prevalence of co-morbid diseases and aetiologies among patients with HF, including hypertension and ischemia. The study sheds light on what continues to impact hospitalized HF patients' morbidity and mortality, aiding meaningful interventions to improve patient outcomes. Cardiac & Cardiovascular Systems Heart failure Hospital registry Management Bangladesh Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background Heart failure (HF) is a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and is corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion [ 1 ]. The estimated prevalence of HF in the adult population is 1–2%, increasing to 10% in older adults [ 2 ]. HF often leads to gradual or acute changes in HF symptoms that require repeated and prolonged hospitalization. Hospital admission is a strong predictor of further hospital admission: 20–25% of patients with HF are rehospitalized within 1 month and approximately 50% within 5 months of discharge [ 3 ]. Decompensation requiring hospitalization is also linked to increased mortality. A European registry study following patients for 1 year after hospitalization reported mortality rates of 24% for acute HF and 6.4% for chronic HF [ 4 ]. An early return to the hospital following discharge may be a result of incomplete inpatient treatment and poor coordination and planning of follow-up care. Even for patients with regular follow-up care, however, the signs of decompensation may not occur during cardiology visits [ 5 ]. A global study showed that patients HF from low and middle-income countries reported that participants from Southeast Asia had an intermediate rate of mortality at the mean age of 57 years (15%) compared with patients in China, USA, and the Middle East patients who had the lowest rates of death at the mean age of 60 years, 69 years, and 72 years (7.3%, 9.1%, and 9.4%), respectively [ 14 ]. In contrast to developed countries, there are limited studies in developing countries like Bangladesh. The goals of the United Hospital Registry on Heart Failure Outcome are: (i) to describe the demographic, clinical, and biological characteristics of patients treated in cardiology centre; (ii) to describe the diagnostics and therapeutic approaches routinely undertaken to assist patients with HF during the hospital phase and to assist patients with HF in the subsequent follow-up; (iii) to assess the in-hospital and out-of-hospital outcome of patients with HF and the prognostic predictors of this outcome; and (iv) to evaluate how the recommendations of the most recent international guidelines are adopted in clinical practice and how their application can impact on patient outcomes. Hence, this study creating awareness regarding HF prognostic factors, management, and all-cause mortality among HF patients who visited the United Hospital Cardiac Unit in Bangladesh. Therefore, the aim of this study is to describe baseline clinical profiles and the outcome of patients vsisted to hospital for an HF episode. Methods Study design and settings This retrospective cross-sectional study was conducted at Department of Cardiology, United Hospital, Dhaka, Bangladesh. The study hospital is the country’s one of the largest specialised hospitals where people come from across the country due to availability and potential access to better cardiac treatment options. Participants and survey procedures All consecutive HF patients fulfilling the inclusion criteria were included. Patients were included if they fulfilled the following inclusion criteria: (i) HF patients receiving treatment, (iii) able to respond to the questions, and (iv) willing to participate in the study. Data were collected from heart failure hospital registry between January 2020 and December 2024. Patients’ sociodemographic characteristics (age, gender, and monthly household income) and clinical information were included. Patients were asked to sign an informed consent to anonymous management of their individual data. The respondents were not given any financial benefits for participating in the study. We primarily selected a total of 1700 data items for analysis. After eliminating incomplete and insufficient quality information, a total of 1536 data were selected for analytical exploration (Appendix 1). Statistical analysis The collected data were checked for completeness, consistency, clarity, and accuracy. Data was entered into Excel and analyzed. Categorical variables are presented as percentages, whereas continuous variables are presented as their means and standard deviation (SD). Results Participant’s basic characteristics Patient’s basic characteristics are present in Table 1. A total of 1536 patients with HF participated in our study. Of those, most were male (84%, n=1292) and older than 55 years (62%, n=949). Approximately 39%(n=596) of the patients’ monthly income was more than 60 thousand Bangladesh Taka. Table 1: Patients’ basic characteristics (N=1536) Characteristics Frequency Percentage Gender Male 1292 84.11 Female 244 15.89 Age in years (mean ±SD 53.2±6.5) 55 949 61.78 Monthly Income (BDT) 60000 596 38.80 Patient’s clinical characteristics According to the classification of the New York Heart Association (NYHA), most patients (73%, n=1128) with HF were classified as class II followed by class III (19%, n=286) in the first visit. In the last visit, most of patients (86%, n=1321) with HF were classified as class II followed by class III (9%, n=143). In terms of Electrocardiogram (ECG), 1466 patients had rhythm reports where 98% (n=1440) had normal heart rhythm (sinus). In total, 321 subjects had Bundle Brunch Block (BBB) reports, which included 71% (n=228) who had LBBB, followed by 28% (n=89) who had RBBB. A total of 35 patients had a history of heart block, and 94% (n=33) of them had first-degree blocks. A total of 1449 patients had reports on ECG QRS duration (milli second) while 941 (65%) of them had an ECG QRS duration of less than 130 milliseconds followed by 318 (22%) had >150 milliseconds. Echo reports showed 1529 patients with left ventricular internal diameter end diastole (LVIDD) measurements, with the majority of them (45%, n= 688) having an LVIDD of 51- 60 millimetres. Nevertheless, 1526 patients had left ventricular internal diameter end-systole (LVIDs) measurements, with the majority (38%, n= 573) having 41-50 mm LVIDs. A total of 994 patients' pulmonary artery systolic pressures (PASPs) were measured, and the majority (53%, n = 527) had a PASP of less than 30mm. Nearly two-thirds of patients (73%, n=1123) had a history of Heart failure with reduced ejection fraction (HFrEF). A significant improvement was observed in the patients' 6-minute walk test. Before treatment, 10.5% of patients had poor functional capacity, which decreased to 8% after treatment, a reduction of 2%. Table 2: Patient’s clinical characteristics (n=1536) Variables Frequency Percentage The New York Heart Association (NYHA) classification (first visit) Class I 118 7.68 Class II 1128 73.43 Class III 286 18.61 Class IV 4 0.26 The New York Heart Association (NYHA) classification (last visit) Class I 62 4.03 Class II 1321 86.00 Class III 143 9.30 Class IV 9 0.58 Electrocardiogram (ECG) Rhythm (n=1466) Sinus 1440 98.23 Atrial Fibrillation (AF) 26 1.77 Bundle Branch Block (n= 321) Right Bundle Branch Block (RBBB) 89 27.73 Left Bundle Branch Block (LBBB) 228 71.03 Left anterior fascicular block (LAHB) 4 1.24 Heart Block (n=35) First degree 33 94.29 Third degree 2 5.71 ECG QRS duration (milli second) (n=1449) 150 ms 318 21.95 Echocardiogram (Echo) Left ventricular internal diameter end diastole (LVIDD) (in milli meter) (n=1529) 30-40 mm 49 3.21 41-50 mm 348 22.76 51-60 mm 688 45.00 > 60 mm 444 29.04 Left ventricular internal diameter end systole (LVIDs) (in milli meter) (n=1526) 20-30 mm 118 7.73 31-40 mm 383 25.10 41-50 mm 573 37.55 Out of Range (< 20) 452 29.62 Pulmonary artery systolic pressure (PASP) (in milli meter) (n=994) 50 mm 117 11.77 Category of Heart Failure (n=1536) Heart failure with reduced ejection fraction (HFrEF) 1123 73.11 Heart Failure with mid-range ejection fraction (HFmEF) 138 8.98 Heart failure with preserved ejection fraction (HFpEF) 108 7.03 Heart failure with improved ejection fraction (HFimpEF) 161 10.48 Others 6 0.39 6-minute walk test (before) Poor 161 10.50 Fair 190 12.00 Good 963 63.00 Very Good 222 14.50 6-minute walk test (after) Poor 122 8.00 Fair 131 8.50 Good 986 64.00 Very Good 297 19.50 Comorbid conditions Out of 1536 patients, 584 (73%) had comorbid conditions. Of these, the most common comorbid conditions were associated coronary artery disease (CAD) (59%, n=903) renal failure (17%, n=256), and asthma (9%, n=140) (Figure 1). Coronary risk factors Figure 2 shows the most common coronary risk factors. Hypertension (67.58%, n=1038), diabetes (55.46%, n=852) and smoking history (33.33%, n=512) were the most common risk factor among HF patients. Ischemia Overall, 1246 patients (81%) were diagnosed as ischemic patients. Medicine Antiplatelet (94%, n=1379), beta blocker (88%, n=1291), diuretic (72%, n=1057), Sodium-glucose cotransporter-2 (SGLT2) inhibitors (63%, n=925), Angiotensin Receptor-Neprilysin Inhibitor (ARNI) (49%, n=719) and anti-anginal (48%, n=705) were most common medication (Fig-4). Device therapy Overall, 78 patients received the device, 54 (66%) had automatic implantable cardioverter defibrillator (AICD), and 28 (34%) had cardiac resynchronization therapy with a defibrillator (CRTD) (Figure 5). Hospitalisation Figure 6 shows the hospitalisation rate. Out of 1536 patients, 172 (11%) patients were hospitalised. Death According to the records, 226 (15%) patients died, 72% (n=162) from cardiovascular causes and 28% from non-cardiovascular causes (Figure 7). Discussion Our study has observed HF patients’ profiles, management and outcome in a tertiary care HF clinic, Dhaka, Bangladesh. This study included 1536 patents from an HF registry where 84% were male. Nearly two-thirds of patients (73%) had comorbid conditions, with the most common conditions being coronary artery disease (CAD) (59%) and renal failure (17%). Among 1536 patients, 62% were older than 55 years old, with a mean (±SD) age of 53.2±6.5 years. We observe disparities when we compare the demographic characteristics of patients with HF revealed by this study with data from other studies. For example, in Ethiopia, 66.8% were younger than 65 years old, with a mean (±SD) age of 52.4±17.9 years [6], in Spain, 66.7% of HF patients were older than 65 years, with a mean (± SD) age of 72.8 ± 11.2 years [7], and in the USA, almost 75% of HF patients were less than 65 years, with a mean (± SD) age of 69.1 ± 13.5 years [8]. Moreover, a comparable previous study conducted in several Asian countries found that more than 50% of HF patients were < 65 years old [9]. This disparity may be caused by factors such as living styles, socioeconomic status, genetics, and environmental factors. Another aspect of the issue may be the lack of preventive care and screening for heart disease risk factors, which may account for the fact that many people in LMICs, such as Bangladesh, develop HF at a young age and have poorer outcomes. According to our data, 85% of HF patients in this study had NYHA class II which is much higher than a recent Ethiopian study, in which only 1.4% of HF patients had NYHA class II [6]. Another study from Japan found that most patients (75%) had NYHA class III–IV, which is relatively different from our study [10]. This demonstrates that HF patients in Bangladesh come with primary-stage symptoms when they visit a health facility. The current initiative for available health care access in study hospital, socio-economic status of the patients, high level of awareness about the disease, and the quality of health care services might be all likely factors in these primary-stage presentations. In line with our findings, a number of studies found hypertensin is the most common HF risk factors. For example, Studies conducted in the USA (75.6%) [8], New Zealand and Singapore (67.8%) [11], Tanzania (41%) [12], and South Africa (46%) [13], hypertension was the most common risk factor for HF patients. In this study, the possible causes of the high proportion of hypertension as a risk factor for HF were a lack of adherence to salt intake recommendations, inadequate quality of health care services, the poor lifestyle of the patients, poor diet monitoring habits, race variation, environmental, and genetic factors. The most common precipitating variables in the current study are coronary artery disease (CAD) (59%) followed by renal failure, and asthma (9%). An Ethiopian study revealed that pneumonia (42%) was the most common cause of HF exacerbation, followed by arrhythmia, anemia, myocardial infarction, and drug discontinuation [6]. This difference is due to the sociodemographic component of the study which has resulted in disparities in findings. In our study, antiplatelet (94%), beta blocker (88%), diuretic (72%), SGLT2 inhibitors (63%), ARNI (49%) and anti-anginal (48%) were most common medication. Studies f from Ethiopia [14], Japan [15], New Zealand and Singapore [11] showed that diuretics were used most commonly, followed by beta-blockers, ACEIs/ARBs, mineralocorticoid receptor antagonists, and statins for HF patients. Exercise capacity is one of the strongest predictors of survival in patients with heart failure. A number of studies have investigated whether the distance walked during the walking test is a prognostic indicator in heart failure patients [16]. Lower levels of functional capacity (a distance <300 m during 6MWT) have proven to be predictive of mortality (total or cardiovascular) and morbidity (hospitalization for worsening heart failure). We observed a significant improvement was observed in the patients' 6-minute walk test. Before treatment, 10.5% of patients had poor functional capacity, which decreased to 8% after treatment, a reduction of 2%. Our findings underscore the clinical importance and support the use of 6MWT in the assessment of patients with HF. Surprisingly, the hospitalisation rate in our study was 11% which is lower than other studies conducted in Bangladesh [17]. This could be attributed to improved healthcare facilities and increased public health awareness in the region. Additionally, the study might have involved a population with better access to preventive measures and healthcare services. Variations in data collection methods and sample size could also account for the differences observed. In our study, non-cardiac death was also not uncommon. These results may be due to the older age, many co-morbidities, and concomitant illnesses, such as infections, in HF patients in clinical settings. Limitations and strength The study had some limitations. The study was conducted in a single tertiary care hospital in Dhaka, which may limit the generalizability of the results. Despite this limitation, our study provides vital information on the clinical characteristics, management, and prognosis of HF patients. Conclusion In conclusion, the hospital registry provides a greater understanding of the characteristics, treatment patterns and outcomes of HF patients in a leading referral centre in Bangladesh. The most common co-morbid diseases and aetiology in patients with HF were coronary artery disease and renal failure. Furthermore, diabetes was the principal precipitating factor of HF. This study shed light on what continues to impact morbidity and mortality of HF patients, aiding the implementation of meaningful interventions to improve patient outcome for HF patients across the world. Declarations Data availability Data can be shared with the corresponding author upon request and for a valid reason. Funding We did not receive any financial support to conduct this study. Conflicts of interest The authors have no conflicts of interest. Ethics approval To ensure compliance with ethical standards and participant confidentiality, we obtained ethical approval from the Bangladesh Medical Research Council (BMRC) (Ref-25003092019). The data were de-identified to maintain anonymity prior to analysis. Before data collection, the purpose of the study was fully clarified to the participants, and their informed written consent was taken. Each of the steps of this study was completed following the Helsinki Declaration (1964). Authors’ contributions All authors critically reviewed earlier versions of the draft and approved the final manuscript. MAH, MAH, SN and NAMM conceived the paper. MAH, SN, HU, TAK and NAM developed the analysis plan. MAH, KNK, AMS, FB, RR, SWC, GM, ZZ, SB, FUS, SM and FMM wrote the initial draft. All author contributed to the write up and editing. NAMM supervised the study. Acknowledgments We thank every participant for their voluntarily participation. We also grateful to hospital authority for allowing us conducting the study. References Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N et al (2021) Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail 23(3):352–380 Cardiovascular Diseases. 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Bangladesh","correspondingAuthor":true,"prefix":"","firstName":"Faroque","middleName":"Md","lastName":"Moh","suffix":"Md"},{"id":424138881,"identity":"aeb4344b-fb2e-4a48-bf46-3a29814d311d","order_by":15,"name":"N A M Momenuzzaman","email":"","orcid":"","institution":"Department of Cardiology, United Hospital, Dhaka-1212, Bangladesh","correspondingAuthor":false,"prefix":"","firstName":"N","middleName":"A M","lastName":"Momenuzzaman","suffix":""}],"badges":[],"createdAt":"2025-03-04 18:54:06","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6156668/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6156668/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78154151,"identity":"5de5178c-0998-4e2e-87d4-017d582272f3","added_by":"auto","created_at":"2025-03-10 12:10:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":7810,"visible":true,"origin":"","legend":"\u003cp\u003eList of common co-morbid diseases that co-exist with HF patients\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-6156668/v1/e0b203b9d77027ce93da633b.png"},{"id":78154574,"identity":"2c97f754-8220-4c8d-822e-96f95c02943d","added_by":"auto","created_at":"2025-03-10 12:18:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":10171,"visible":true,"origin":"","legend":"\u003cp\u003eList of coronary risk factors\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-6156668/v1/e69c1da3a35b80819cdbeedb.png"},{"id":78154153,"identity":"0a0b07a3-2029-46b2-91bb-7c19d78e86de","added_by":"auto","created_at":"2025-03-10 12:10:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":14653,"visible":true,"origin":"","legend":"\u003cp\u003ePatients’ presentation with ischemia\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-6156668/v1/7f7bc204213fa7a2b18279e6.png"},{"id":78155529,"identity":"32967a51-c029-48f8-a13d-a12482c766fa","added_by":"auto","created_at":"2025-03-10 12:26:31","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":23443,"visible":true,"origin":"","legend":"\u003cp\u003eHistory of medication\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-6156668/v1/3fa08cd9c402499d3b63d536.png"},{"id":78154578,"identity":"5fa5b9f8-b2ef-4bc2-8654-a27bba6c18b1","added_by":"auto","created_at":"2025-03-10 12:18:31","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":18703,"visible":true,"origin":"","legend":"\u003cp\u003eReceived device therapy\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-6156668/v1/f52382904c3f5e5feedfb816.png"},{"id":78154585,"identity":"3c831eb4-597e-4095-b7d2-816e9b23e6cb","added_by":"auto","created_at":"2025-03-10 12:18:31","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":15141,"visible":true,"origin":"","legend":"\u003cp\u003eHospitalisation history\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-6156668/v1/78de3eb37c1913348d3e49df.png"},{"id":78154172,"identity":"aba47ab5-1fe2-48cf-b67c-79ae38149407","added_by":"auto","created_at":"2025-03-10 12:10:31","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":65735,"visible":true,"origin":"","legend":"\u003cp\u003ePatient death history\u003c/p\u003e","description":"","filename":"image7.png","url":"https://assets-eu.researchsquare.com/files/rs-6156668/v1/dcfc2bcd142ed7919a7af5d6.png"},{"id":78155866,"identity":"290f2a9c-81be-40c0-8fef-dd6cd579baf3","added_by":"auto","created_at":"2025-03-10 12:34:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1005128,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6156668/v1/90e2c0d3-80a3-4704-af52-ce83c45cb7ad.pdf"},{"id":78155865,"identity":"78d0ce2d-2ae7-4b55-a6c8-76b0e4f6304c","added_by":"auto","created_at":"2025-03-10 12:34:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":28970,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6156668/v1/ff42ab75a7da7b82f4ea4714.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eHeart Failure Patient Profiles, Management and Outcome: Results from a Heart Failure Clinic Registry\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eHeart failure (HF) is a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and is corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The estimated prevalence of HF in the adult population is 1\u0026ndash;2%, increasing to 10% in older adults [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. HF often leads to gradual or acute changes in HF symptoms that require repeated and prolonged hospitalization. Hospital admission is a strong predictor of further hospital admission: 20\u0026ndash;25% of patients with HF are rehospitalized within 1 month and approximately 50% within 5 months of discharge [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Decompensation requiring hospitalization is also linked to increased mortality. A European registry study following patients for 1 year after hospitalization reported mortality rates of 24% for acute HF and 6.4% for chronic HF [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn early return to the hospital following discharge may be a result of incomplete inpatient treatment and poor coordination and planning of follow-up care. Even for patients with regular follow-up care, however, the signs of decompensation may not occur during cardiology visits [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA global study showed that patients HF from low and middle-income countries reported that participants from Southeast Asia had an intermediate rate of mortality at the mean age of 57 years (15%) compared with patients in China, USA, and the Middle East patients who had the lowest rates of death at the mean age of 60 years, 69 years, and 72 years (7.3%, 9.1%, and 9.4%), respectively [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In contrast to developed countries, there are limited studies in developing countries like Bangladesh. The goals of the United Hospital Registry on Heart Failure Outcome are: (i) to describe the demographic, clinical, and biological characteristics of patients treated in cardiology centre; (ii) to describe the diagnostics and therapeutic approaches routinely undertaken to assist patients with HF during the hospital phase and to assist patients with HF in the subsequent follow-up; (iii) to assess the in-hospital and out-of-hospital outcome of patients with HF and the prognostic predictors of this outcome; and (iv) to evaluate how the recommendations of the most recent international guidelines are adopted in clinical practice and how their application can impact on patient outcomes. Hence, this study creating awareness regarding HF prognostic factors, management, and all-cause mortality among HF patients who visited the United Hospital Cardiac Unit in Bangladesh. Therefore, the aim of this study is to describe baseline clinical profiles and the outcome of patients vsisted to hospital for an HF episode.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and settings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cross-sectional study was conducted at Department of Cardiology, United Hospital, Dhaka, Bangladesh. The study hospital is the country\u0026rsquo;s one of the largest specialised hospitals where people come from across the country due to availability and potential access to better cardiac treatment options.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and survey procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll consecutive HF patients fulfilling the inclusion criteria were included. Patients were included if they fulfilled the following inclusion criteria: (i) HF patients receiving treatment, (iii) able to respond to the questions, and (iv) willing to participate in the study.\u003c/p\u003e\n\u003cp\u003eData were collected from heart failure hospital registry between January 2020 and December 2024. Patients\u0026rsquo; sociodemographic characteristics (age, gender, and monthly household income) and clinical information were included. Patients were asked to sign an informed consent to anonymous management of their individual data. The respondents were not given any financial benefits for participating in the study. We primarily selected a total of 1700 data items for analysis.\u0026nbsp; After eliminating incomplete and insufficient quality information, a total of 1536 data were selected for analytical exploration (Appendix 1). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe collected data were checked for completeness, consistency, clarity, and accuracy. Data was entered into Excel and analyzed. Categorical variables are presented as percentages, whereas continuous variables are presented as their means and standard deviation (SD).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant\u0026rsquo;s basic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatient\u0026rsquo;s basic characteristics are present in Table 1. A total of 1536 patients with HF participated in our study. Of those, most were male (84%, n=1292) and older than 55 years (62%, n=949). Approximately 39%(n=596) of the patients\u0026rsquo; monthly income was more than 60 thousand Bangladesh Taka.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Patients\u0026rsquo; basic characteristics\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(N=1536)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e84.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in years\u003c/strong\u003e (mean \u0026plusmn;SD 53.2\u0026plusmn;6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;18-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;31-55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026gt; 55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e61.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly Income (BDT)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;20000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;20000-40000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;40000-60000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026gt;60000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePatient\u0026rsquo;s clinical characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the classification of the New York Heart Association (NYHA), most patients (73%, n=1128) with HF were classified as class II followed by class III (19%, n=286) in the first visit. In the last visit, most of patients (86%, n=1321) with HF were classified as class II followed by class III (9%, n=143). In terms of Electrocardiogram (ECG), 1466 patients had rhythm reports where 98% (n=1440) had normal heart rhythm (sinus). In total, 321 subjects had Bundle Brunch Block (BBB) reports, which included 71% (n=228) who had LBBB, followed by 28% (n=89) who had RBBB. \u0026nbsp; A total of 35 patients had a history of heart block, and 94% (n=33) of them had first-degree blocks. A total of 1449 patients had reports on ECG QRS duration (milli second) while 941 (65%) of them had an ECG QRS duration of less than 130 milliseconds followed by 318 (22%) had \u0026gt;150 milliseconds.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEcho reports showed 1529 patients with left ventricular internal diameter end diastole (LVIDD) measurements, with the majority of them (45%, n= 688) having an LVIDD of 51- 60 millimetres. Nevertheless, 1526 patients had left ventricular internal diameter end-systole (LVIDs) measurements, with the majority (38%, n= 573) having 41-50 mm LVIDs. A total of 994 patients\u0026apos; pulmonary artery systolic pressures (PASPs) were measured, and the majority (53%, n = 527) had a PASP of less than 30mm. Nearly two-thirds of patients (73%, n=1123) had a history of \u0026nbsp; Heart failure with reduced ejection fraction (HFrEF). A significant improvement was observed in the patients\u0026apos; 6-minute walk test. Before treatment, 10.5% of patients had poor functional capacity, which decreased to 8% after treatment, a reduction of 2%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Patient\u0026rsquo;s clinical characteristics\u003c/strong\u003e (n=1536)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe New York Heart Association (NYHA) classification (first visit)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Class I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Class II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e73.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Class III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Class IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe New York Heart Association (NYHA) classification (last visit)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Class I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Class II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e86.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Class III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Class IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eElectrocardiogram (ECG)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eRhythm (n=1466)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Sinus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1440\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e98.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Atrial Fibrillation (AF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003eBundle Branch Block (n= 321)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Right Bundle Branch Block (RBBB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Left Bundle Branch Block (LBBB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e71.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Left anterior fascicular block (LAHB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003eHeart Block (n=35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; First degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Third degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003eECG QRS duration (milli second) (n=1449)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026lt; 130 ms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 130 \u0026ndash; 140 ms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026gt; 150 ms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEchocardiogram (Echo)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;Left ventricular internal diameter end diastole (LVIDD) (in milli meter) (n=1529)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 30-40 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 41-50 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 51-60 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e45.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026gt; 60 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft ventricular internal diameter end systole (LVIDs) (in milli meter) (n=1526)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 20-30 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 31-40 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 41-50 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e37.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Out of Range (\u0026lt; 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e29.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003ePulmonary artery systolic pressure (PASP) (in milli meter) (n=994)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026lt; 30 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e53.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 30-40 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; 41-50 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026gt; 50 mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory of Heart Failure (n=1536)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Heart failure with reduced ejection fraction (HFrEF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e73.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Heart Failure with mid-range ejection fraction (HFmEF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Heart failure with preserved ejection fraction (HFpEF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Heart failure with improved ejection fraction (HFimpEF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e6-minute walk test (before)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e63.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eVery Good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e6-minute walk test (after)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e986\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eVery Good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eComorbid conditions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 1536 patients, 584 (73%) had comorbid conditions. Of these, the most common comorbid conditions were associated coronary artery disease (CAD) (59%, n=903) renal failure (17%, n=256), and asthma (9%, n=140) (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCoronary risk factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2 shows the most common coronary risk factors. Hypertension (67.58%, n=1038), diabetes (55.46%, n=852) and smoking history (33.33%, n=512) were the most common risk factor among HF patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIschemia\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 1246 patients (81%) were diagnosed as ischemic patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMedicine\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAntiplatelet (94%, n=1379), beta blocker (88%, n=1291), diuretic (72%, n=1057), Sodium-glucose cotransporter-2 (SGLT2) inhibitors (63%, n=925), Angiotensin Receptor-Neprilysin Inhibitor (ARNI) (49%, n=719) and anti-anginal (48%, n=705) were most common medication (Fig-4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDevice therapy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 78 patients received the device, 54 (66%) had automatic implantable cardioverter defibrillator (AICD), and 28 (34%) had cardiac resynchronization therapy with a defibrillator (CRTD) (Figure 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHospitalisation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 6 shows the hospitalisation rate. Out of 1536 patients, 172 (11%) patients were hospitalised.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeath\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the records, 226 (15%) patients died, 72% (n=162) from cardiovascular causes and 28% from non-cardiovascular causes (Figure 7).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study has observed HF patients’ profiles, management and outcome in a tertiary care HF clinic, Dhaka, Bangladesh. This study included 1536 patents from an HF registry where 84% were male. Nearly two-thirds of patients (73%) had comorbid conditions, with the most common conditions being coronary artery disease (CAD) (59%) and renal failure (17%). Among 1536 patients, 62% were older than 55 years old, with a mean (±SD) age of 53.2±6.5 years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe observe disparities when we compare the demographic characteristics of patients with HF revealed by this study with data from other studies. For example, in Ethiopia, 66.8% were younger than 65\u0026nbsp;years old, with a mean (±SD) age of 52.4±17.9\u0026nbsp;years [6], in Spain, 66.7% of HF patients were older than 65 years, with a mean (± SD) age of 72.8 ± 11.2 years [7], and in the USA, almost 75% of HF patients were less than 65 years, with a mean (± SD) age of 69.1 ± 13.5 years [8]. Moreover, a comparable previous study conducted in several Asian countries found that more than 50% of HF patients were \u0026lt; 65 years old [9]. This disparity may be caused by factors such as living styles, socioeconomic status, genetics, and environmental factors.\u0026nbsp;Another aspect of the issue may be the lack of preventive care and screening for heart disease risk factors, which may account for the fact that many people in LMICs, such as Bangladesh, develop HF at a young age and have poorer outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to our data, 85% of HF patients in this study had NYHA class II which is much higher than a recent Ethiopian study, in which only 1.4% of HF patients had NYHA class II [6]. \u0026nbsp;Another study from Japan found that most patients (75%) had NYHA class III–IV, which is relatively different from our study [10]. This demonstrates that HF patients in Bangladesh come with primary-stage symptoms when they visit a health facility. The current initiative for available health care access in study hospital, socio-economic status of the patients, high level of awareness about the disease, and the quality of health care services might be all likely factors in these primary-stage presentations.\u003c/p\u003e\n\u003cp\u003eIn line with our findings, a number of studies found hypertensin is the most common HF risk factors. For example, Studies conducted in the USA (75.6%) [8], New Zealand and Singapore (67.8%) [11], Tanzania (41%) [12], and South Africa (46%) [13], hypertension was the most common risk factor for HF patients. In this study, the possible causes of the high proportion of hypertension as a risk factor for HF were a lack of adherence to salt intake recommendations, inadequate quality of health care services, the poor lifestyle of the patients, poor diet monitoring habits, race variation, environmental, and genetic factors.\u003c/p\u003e\n\u003cp\u003eThe most common precipitating variables in the current study are coronary artery disease (CAD) (59%) followed by renal failure, and asthma (9%).\u0026nbsp;An Ethiopian study revealed that pneumonia (42%) was the most common cause of HF exacerbation, followed by arrhythmia, anemia, myocardial infarction, and drug discontinuation [6]. This difference is due to the sociodemographic component of the study which has resulted in disparities in findings. \u0026nbsp;In our study, antiplatelet (94%), beta blocker (88%), diuretic (72%), SGLT2 inhibitors (63%), ARNI (49%) and anti-anginal (48%) were most common medication. Studies f from Ethiopia [14], Japan [15], New Zealand and Singapore [11] showed that diuretics were used most commonly, followed by beta-blockers, ACEIs/ARBs, mineralocorticoid receptor antagonists, and statins for HF patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExercise capacity is one of the strongest predictors of survival in patients with heart failure. A number of studies have investigated whether the distance walked during the walking test is a prognostic indicator in heart failure patients [16]. Lower levels of functional capacity (a distance \u0026lt;300 m during 6MWT) have proven to be predictive of mortality (total or cardiovascular) and morbidity (hospitalization for worsening heart failure). We observed a significant improvement was observed in the patients' 6-minute walk test. Before treatment, 10.5% of patients had poor functional capacity, which decreased to 8% after treatment, a reduction of 2%. \u0026nbsp;Our findings underscore the clinical importance and support the use of 6MWT in the assessment of patients with HF. Surprisingly, the hospitalisation rate in our study was 11% which is lower than other studies conducted in Bangladesh [17]. This could be attributed to improved healthcare facilities and increased public health awareness in the region. Additionally, the study might have involved a population with better access to preventive measures and healthcare services. Variations in data collection methods and sample size could also account for the differences observed. In our study, non-cardiac death was also not uncommon. These results may be due to the older age, many co-morbidities, and concomitant illnesses, such as infections, in HF patients in clinical settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and strength\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study had some limitations. The study was conducted in a single tertiary care hospital in Dhaka, which may limit the generalizability of the results. Despite this limitation, our study provides vital information on the clinical characteristics, management, and prognosis of HF patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the hospital registry provides a greater understanding of the characteristics, treatment patterns and outcomes of HF patients in a leading referral centre in Bangladesh. The most common co-morbid diseases and aetiology in patients with HF were coronary artery disease and renal failure. Furthermore, diabetes was the principal precipitating factor of HF. This study shed light on what continues to impact morbidity and mortality of HF patients, aiding the implementation of meaningful interventions to improve patient outcome for HF patients across the world.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData can be shared with the corresponding author upon request and for a valid reason.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe did not receive any financial support to conduct this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors have no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;To ensure compliance with ethical standards and participant confidentiality, we obtained ethical approval from the Bangladesh Medical Research Council (BMRC) (Ref-25003092019). The data were de-identified to maintain anonymity prior to analysis.\u0026nbsp;Before data collection, the purpose of the study was fully clarified to the participants, and their informed written consent was taken. Each of the steps of this study was completed following the Helsinki Declaration (1964).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors critically reviewed earlier versions of the draft and approved the final manuscript. MAH, MAH, SN and NAMM conceived the paper. MAH, SN, HU, TAK and NAM developed the analysis plan. MAH, KNK, AMS, FB, RR, SWC, GM, ZZ, SB, FUS, SM and FMM wrote the initial draft. All author contributed to the write up and editing. NAMM supervised the study. \u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank every participant for their voluntarily participation. We also grateful to hospital authority for allowing us conducting the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N et al (2021) Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur J Heart Fail 23(3):352\u0026ndash;380\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCardiovascular Diseases. The World Health Organization Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)?gad_source=1\u0026amp;gclid=Cj0KCQiA_Yq-BhC9ARIsAA6fbAiyoPIZYsnIf1429z_Eo-aIKFvF2n2RNwKUq8iX3sZhxRtfNYmYq1gaAlOpEALw_wcB\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)?gad_source=1\u0026amp;gclid=Cj0KCQiA_Yq-BhC9ARIsAA6fbAiyoPIZYsnIf1429z_Eo-aIKFvF2n2RNwKUq8iX3sZhxRtfNYmYq1gaAlOpEALw_wcB\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThandra A, Balakrishna AM, Walters RW et al (2023) Trends in and predictors of multiple readmissions following heart failure hospitalization: A National wide analysis from the United States. 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PLoS Med 15(3):e1002541\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarr\u0026eacute; N, Lupon J, Roig E, Gonzalez-Costello J, Vila J, Perez S et al (2017) Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: a multicentre prospective observational study in Catalonia (Spain). BMJ Open 7(12):e018719\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLam CS, Gamble GD, Ling LH, Sim D, Leong KTG, Yeo PSD et al (2018) Mortality associated with heart failure with preserved vs. reduced ejection fraction in a prospective international multi-ethnic cohort study. Eur Heart J 39(20):1770\u0026ndash;1780\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaphael DM, Roos L, Myovela V, Mchomvu E, Namamba J, Kilindimo S, Gingo W, Hatz C, Paris DH, Weisser M, Kobza R, Rohacek M (2018) Heart diseases and echocardiography in rural Tanzania: Occurrence, characteristics, and etiologies of underappreciated cardiac pathologies. PLoS ONE 13(12):e0208931\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKraus S, Ogunbanjo G, Sliwa K, Ntusi NA (2016) Heart failure in sub-Saharan Africa: a clinical approach. SAMJ South Afr Med J 106(1):23\u0026ndash;31\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbebe TB, Gebreyohannes EA, Tefera YG, Abegaz TM (2016) Patients with HFpEF and HFrEF have different clinical characteristics but similar prognosis: a retrospective cohort study. BMC Cardiovasc Disord 16(1):232\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShiga T, Suzuki A, Haruta S, Mori F, Ota Y, Yagi M et al (2019) Clinical characteristics of hospitalized heart failure patients with preserved, mid-range, and reduced ejection fractions in Japan. ESC Heart Fail 6(3):475\u0026ndash;486\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaggiano P, D'Aloia A, Gualeni A, Brentana L, Dei Cas L (2004) The 6 minute walking test in chronic heart failure: indications, interpretation and limitations from a review of the literature. Eur J Heart Fail 6(6):687\u0026ndash;691\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkhtar Z, Aleem MA, Ghosh PK et al (2021) In-hospital and 30-day major adverse cardiac events in patients referred for ST-segment elevation myocardial infarction in Dhaka, Bangladesh. BMC Cardiovasc Disord 21:85\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"North South University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Heart failure, Hospital registry, Management, Bangladesh","lastPublishedDoi":"10.21203/rs.3.rs-6156668/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6156668/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eHeart failure (HF) is characterised by frequent decompensation and an unpredictable trajectory. The prevalence of heart failure has increased from 43.4 to 46.5% in the last 10 years in lower and middle-income countries like Bangladesh. This study aims to describe baseline clinical profiles, management strategies, and the in-hospital outcome of patients visited hospital for HF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eA retrospective observational study was conducted on HF patients at a tertiary care hospital in Bangladesh. Relevant data were collected from patients’ medical records.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 1536 patients with HF were included in our study. Of those, most were male (84%) and older than 55 years (62%) (mean (±SD) 53.2±6.5 years). A significant improvement was observed in the patients' functional status as defined by The New York Heart Association (NYHA) class. A total of 35 patients had a history of heart block, and 94% of them had first-degree blocks. Nearly two-thirds of patients (73%) had a history of heart failure with reduced ejection fraction (HFrEF). A significant change was observed in the patients' 6-minute walk test. Most common comorbid conditions were associated coronary artery disease (59%) followed by renal failure (17%). Hypertension (67%) and diabetes (55%) were the most common coronary risk factors. 1246 patients (81%) were diagnosed as ischemic patients. \u0026nbsp;Beta blocker (88%), diuretic (72%), SGLT2 inhibitors (63%), and ARNI (49%) were most common medication. Overall, 78 patients received device where 54 patients (66%) used ACID and 28 (34%) used CRTD. A total of 226 patients died, 72% from cardiovascular and 28% from non-cardiovascular causes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThere was a high prevalence of co-morbid diseases and aetiologies among patients with HF, including hypertension and ischemia. The study sheds light on what continues to impact hospitalized HF patients' morbidity and mortality, aiding meaningful interventions to improve patient outcomes.\u003c/p\u003e","manuscriptTitle":"Heart Failure Patient Profiles, Management and Outcome: Results from a Heart Failure Clinic Registry","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-10 12:10:26","doi":"10.21203/rs.3.rs-6156668/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"83940872-d34e-4002-a8a8-6232070ca1c8","owner":[],"postedDate":"March 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45199517,"name":"Cardiac \u0026 Cardiovascular Systems"}],"tags":[],"updatedAt":"2025-03-10T12:10:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-10 12:10:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6156668","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6156668","identity":"rs-6156668","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}