The study was carried out after obtaining Institutional Ethics Committee (IEC) clearance (letter no. IEC 516/2013). A retrospective analysis of 250 HF patients diagnosed between 01 January 2010 and 30 September 2013 was done. Patients of both sexes above 18 years of age, diagnosed as HF (based on Framingham criteria) and patients with associated co-morbidities were included in the study. Patients with end organ disease of kidney, liver and lung developed before developing HF and loss of follow-up at one month were excluded. All the patients were divided into two groups (Left Ventricular Systolic Dysfunction LVSD and Preserved Systolic Function PSF) based on ejection fraction. LVSD is ejection fraction less than equal to 40% whereas PSF is ejection fraction more than 40%. The following details were collected using the proforma which included demography (age, gender), medical history of the patients and medication history for HF patients on admission & discharge, ejection fraction, median length of stay in hospital, number of readmissions and in-hospital mortality.

Statistical analysis was analysed using SPSS software version 16.0. Parametric data was analysed by independent t-test and repeated measures Analysis of Variance (ANOVA) while non-parametric data was analysed by Chi-square test for strength of association. Mann-Whitney U test was used for skewed data. Outcome measures were analysed using logistic regression.

Among the 250 patients mortality was seen in 32 patients during inpatient management while remaining 218 patients recovered after treatment and was discharged. Among the 218 patients 31 patients had readmission to the hospital within one month (due to heart failure symptoms) while remaining 187 patients came for follow-up at the end of one month. Among 250 HF patients, 92 patients had hypertension (diagnosed cases) and 91 patients had type 2 diabetes mellitus (diagnosed cases) as major co-morbidities.

As shown in [Table/Fig-1], there were 128 patients categorized into LVSD group (ejection fraction <40%) and 122 patients in PSF group (ejection fraction > 40%). Mean age of both the groups was comparable and was not statistically significant. Male patients showed higher preponderance than females in both the groups and there was statistical significant difference between the two groups with p-value < 0.05. Medical history of coronary artery disease was significantly higher in LVSD group (p<0.05) and anaemia was significantly higher in PSF group than LVSD group (p<0.05).

As shown in [Table/Fig-2], Inotropes, Digoxin and Statins were prescribed significantly more in patients with LVSD group (p<0.05). Calcium channel blockers were prescribed more in PSF group (p<0.05).

As shown in [Table/Fig-3], there were 218 patients discharged after treatment in hospital for heart failure. Higher number of patients with LVSD group were receiving ACE inhibitors, Beta Blockers, Digoxin, Anti-platelets and statins (p<0.05). Calcium channel blockers and amiodarone were prescribed more in PSF group (p<0.05). The treatment outcome in HF patients were measured with respect to three parameters: length of stay in hospital, in- hospital mortality and readmission within 1 month of discharge.

The median length of stay was slightly higher in patients with PSF as compared to LVSD but there was no statistically significant difference between them [Table/Fig-4]. The median length of stay in hospital was slightly more for HF patients with diabetes/hypertension as compared to patients not having the above co-morbidities but there was no statistical significance as shown in [Table/Fig-5,6] respectively.

In-hospital mortality was lower in patients with PSF (6%) than patients with LVSD (20%) and there was statistically significant difference in mortality (p<0.05) between the two groups as shown in [Table/Fig-4]. After multivariable adjustment, patients with PSF had lesser chance of in-hospital mortality compared to patients with LVSD {adjusted 0.2 (95% CI 0.08 to 0.55; p = 0.001)}. Diabetes and Hypertension were not predictors for causing in-hospital mortality in HF patients as shown in [Table/Fig-5,6 and 7].

The percentage of readmissions within one month was slightly higher in patients with PSF (15%) compared to LVSD (14%) but there was no statistically significant difference between the two groups. Diabetes and hypertension were not predictors for causing readmissions within one month in HF patients as shown in [Table/Fig-5,6 and 7].

HF has been one of the most difficult diseases to treat in modern day life. It is important for the treating physician to treat HF at the earliest after detection and also keep a track of the progress of the patient. As there is no cure for this condition, treatment is focused on improving the quality of life of patients by reducing hospital readmissions and preventing mortality of patients.

The present study assessed various parameters like demographics, medical history of HF patients, medications received on admission & discharge and outcome measures. The present study showed more patients in LVSD than PSF group. However, a study by Fonarow et al., stated that more patients belonged in PSF group than LVSD [10].

The mean age of patients with LVSD were 56.8 ± 13.2 years and patients with PSF 56.4 ± 15.5 years. Although in our study mean age was similar, Fonarow et al., showed that mean age of PSF patients was higher than LVSD patients [10].

Present study showed that males have higher disease preponderance for both LVSD and PSF but study by Fonarow et al., showed higher percentage of male preponderance in LVSD patients [10].

The present study showed higher percentage of LVSD patients were receiving inotropes and nitroglycerine at admission compared to patients with PSF and was consistent with a previous study [11]. Higher numbers of LVSD patients were receiving drugs like ACE inhibitors, beta blockers, digoxin, antiplatelets, nitrates and statins at admission and discharge in comparison to PSF patients. More patients of PSF were receiving calcium channel blockers and angiotensin receptor blockers on admission and discharge compared to LVSD patients. Loop diuretics were prescribed more for LVSD patients than PSF at admission but at discharge they were equally prescribed. The above pattern of medications received at admission and discharge matched with the study conducted by Fonarow et al., [10].

Length of stay in hospital is an important outcome which was measured in our study population. In our study population, the patients with PSF had slightly higher length of stay in hospital compared to LVSD. A report from the OPTIMIZE-HF study reported that median length of stay between the two groups were similar [10]. HF patients with diabetes had a modest increase in length of stay in comparison to patients without diabetes and are consistent with study conducted by Greenberg et al., [12]. The median length of stay in hospital is modestly more in HF patients with hypertension than without hypertension. There are no previous studies showing any comparison of length of stay in hospital among heart failure patients with or without hypertension. However, Ogah et al., showed that median length of stay in HF patients with hypertension was 9 days in his study whereas in our study it is 7 days [13]. Peacock et al., also showed in his study that length of stay in hospital is more than one week in hypertensive HF patients [14].

In hospital mortality of LVSD patients was more than PSF patients in our study. This result was consistent with the study conducted by Fonarow et al., where higher percentage of LVSD patients showed In-hospital mortality [10]. Greenberg et al., showed that in-hospital mortality among HF patients with diabetes and without diabetes were similar [12]. This is not consistent with present study where less mortality was seen in HF patients with diabetes than without diabetes. Present study showed that in-hospital mortality was lower among HF patients with hypertension than without hypertension and is consistent with study conducted by Sato et al., [15]. In our study population we evaluated the number of readmissions occurring within one month post discharge. Kaul et al., showed that HF patients in United States of America and Canada had 20% and 15% chance of readmissions within one month respectively [16]. In the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST) trial 24% of heart failure patients randomized in the United States were readmitted within 30 days of discharge despite the fact that the majority were treated with evidence-based treatment [17]. In our study higher percentage patients with PSF (15%) had readmission compared to LVSD patients (14%). HF patients with diabetes had a slightly higher percentage of readmissions than without diabetes. However, patients with hypertension had lesser percentage of readmissions than without hypertension. There are no previous studies available for comparison of various groups among HF patients for re admissions of patients within 30 days. Fonarow et al., showed that percentage of readmissions during 60- 90 day follow-up were similar between LVSD and PSF patients [10]. Greenberg et al., showed higher percentage of readmissions during 60-90 day follow-up in HF patients with diabetes than patients without diabetes [12].

The limitation of this study is shorter duration of the study. The outcome measures were evaluated only till one month of follow-up. Heart failure is a chronic condition and outcome measures like readmissions and in- hospital mortality are more common at a later time period. Hence the patients have to be evaluated for a longer period to know the actual outcome.

Heart failure is one of the most common heart disorders among Indian population. Treatment of heart failure at the right time is most important. Long term monitoring and treatment adherence should be carried out during the course of treatment.