The Prevalence of Coronary Artery Disease and Its Prognostic Impact on the Management of Patients With Acute Decompensated Heart Failure: A Prospective Cohort Study With a Short-Term Follow-Up.

Introduction Heart failure (HF) poses a major global health challenge, with acute decompensated heart failure (ADHF) representing a critical phase that requires immediate medical intervention. Coronary artery disease (CAD) plays a significant role in many HF cases, contributing to disease progression through myocardial ischemia and impaired ventricular function. While the connection between CAD and HF is well-established, its specific effect on short-term outcomes in patients with ADHF is less understood, especially in regions like the Middle East. This study aims to evaluate the influence of CAD on short-term outcomes in patients presenting with ADHF and identify key differences in demographics, clinical parameters, and outcomes, including intensive care unit (ICU) admissions and medications, between patients with and without CAD, addressing gaps in current understanding and offering insights to improve clinical management. Methods This prospective cohort study was conducted at King Saud University Medical City (KSUMC) in Riyadh, Kingdom of Saudi Arabia (KSA), from April 2023 to April 2024. We included a total of 144 known heart failure patients presenting with acute heart failure (AHF) to the emergency department (ED). Secondary data was collected from the KSUMC medical records database to track patient outcomes after six months. Significant coronary angiography lesions, defined as 70% stenosis or greater, or a history of myocardial ischemia were necessary as evidence of CAD to meet the inclusion criteria. Statistical analyses were conducted using Chi-squared tests for categorical variables and t-tests for continuous variables. All analyses were performed using RStudio version 4.3.1 (Posit Software, Boston, MA), with a significance threshold set at p < 0.05. Results The study included 144 known heart failure patients presenting with acute decompensation, with 83 (57.6%) patients having CAD. CAD patients were younger (median age: 66 versus 67 years, p = 0.026) and predominantly male (75.9% versus 59%, p = 0.031). Diabetes mellitus was significantly more prevalent among patients with CAD (74.7% versus 49.2%, p = 0.002). Ejection fraction (EF) was notably lower in the CAD group with a greater proportion having an ejection fraction of 40% or less (89.2% versus 62.3%, p < 0.001). Additionally, CAD patients had more frequent ICU admissions (37.3% versus 13.1%, p = 0.001) and were more likely to present with chest pain (38.6% versus 21.3%, p = 0.027), while weight loss and lower extremity edema were more common in non-CAD patients (p < 0.05). Despite these worse clinical signs, CAD patients did not have significantly higher mortality at 180 or 360 days. Conclusion Although there was no statistically significant difference in mortality, CAD patients exhibited more severe disease indicators, such as lower ejection fractions and increased ICU hospitalizations. These findings underscore the importance of early detection and tailored treatment strategies for CAD in ADHF patients. Clinicians should prioritize aggressive management of CAD to prevent disease progression and reduce the need for ICU admissions. Future studies should focus on long-term outcomes and explore the impact of specific interventions, such as early revascularization or optimized heart failure therapies, to better understand how CAD influences ADHF prognosis.