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Precipitant in acute heart failure in a multiethnic Asian urban cohort study
  1. Kui Toh Gerard Leong1,
  2. Cao Yan2,
  3. Ping Ping Goh1
  1. 1Department of Cardiology, Changi General Hospital, Singapore
  2. 2Case Management Unit, Changi General Hospital, Singapore
  1. Correspondence to Dr Kui Toh Gerard Leong, Department of Cardiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889; gerard_leong{at}


Objectives To identify acute heart failure (HF) precipitants in patients with a history of chronic HF, and to analyse any relationship with early outcomes.

Background There are limited studies on acute HF precipitants and the relationship with outcomes, and determining this will help to identify the avoidable precipitants and may lead to better outcomes.

Methods Patients with a history of HF and admission to the authors' hospital in 2008, with a discharge primary diagnosis of HF, were enrolled. Diagnosis of HF was prospectively defined and reviewed by two cardiology teams. Patients' case records were reviewed, or families were interviewed for 1-month follow-up outcome information.

Results 242 admissions by 185 patients constituted our study cohort. Patients were older, and 36.8% were females. The ethnic Chinese, Malay and Indian composition of the cohort were 41.3%, 35.1% and 16.1% respectively. The mean left-ventricular ejection fraction was 34.0±17.5%. Preserved left ventricular ejection fraction (≥45%) constituted 35.1% of the cohort. Acute HF precipitants were identified in 62.8% of admissions and unidentified in 37.2% admissions. Non-compliance issues and infections constituted 27.2% and 13.6% of precipitants respectively. Cardiac precipitants accounted for 10.0% admissions. Multiple precipitants accounted for 8.3% admissions. There were no significant differences in patient profile, including ethnicity and gender, and outcomes between patients with identified precipitants and patients with unidentified precipitants.

Conclusion Non-compliance issues were a major precipitant of acute HF in patients with chronic HF. Precipitants were not determined in 37.2% of admissions. There were no significant associations between the different types of precipitants and early 30-day outcomes.

  • Diagnosis of precipitants
  • acute heart failure
  • chronic heart failure
  • outcomes
  • diagnosis
  • heart failure

Statistics from


  • Funding Changi General Hospital Department fund.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the hospital's (CGH) Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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