Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 16, Number 6, December 2025, pages 507-517

De Novo Acute Heart Failure Versus Acute Decompensated Chronic Heart Failure: Are There Differences in In-Hospital Outcomes and Mortality?

Figure 1. Comparison of comorbidities in patients with ad-CHF and dn-AHF. *Valvulopathies were analyzed as a composite variable including aortic (15.0% in ad-CHF vs. 4.6% in dn-AHF; P < 0.001), mitral (30.6% vs. 7.2%; P < 0.001), and tricuspid (15.2% vs. 3.3%; P < 0.001) disease. Missing data for CKD were present in 49 patients (10.3%) in the ad-CHF group and 32 patients (10.5%) in the dn-AHF group, accounting for 10.4% of the overall population. AF: atrial fibrillation; ad-CHF: acute decompensated chronic heart failure; dn-AHF: de novo acute heart failure; CAD: coronary artery disease; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; DVT: deep vein thrombosis; DM: diabetes mellitus; HTN: hypertension; PE: pulmonary embolism.

Figure 2. In-hospital interventions, inotropic agents, and clinical outcomes in patients with ad-CHF and dn-AHF. *Renal function deterioration: increase of more than 0.5 mg/dL in baseline or reported creatinine at admission. **Among those admitted to the ICU, median stay was 5.0 days (IQR 3.0 - 9.0) in the ad-CHF group and 5.0 days (IQR 3.0 - 10.0) in the dn-AHF group; ICU-stay data were missing for 203 (42.9%) ad-CHF and 119 (38.9%) dn-AHF patients. CVC: central venous catheter; ad-CHF: acute decompensated chronic heart failure; dn-AHF: de novo acute heart failure; HF: heart failure; ICU: intensive care unit; IMV: invasive mechanical ventilation; IQR: interquartile range.

Figure 3. Forest plot of Firth penalized multivariable logistic regression for in-hospital mortality. CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; dn-AHF: de novo acute heart failure; OR: odds ratio.

**Table 1.** Baseline Characteristics of the Study Population
Variable	Ad-CHF (n = 474)	Dn-AHF (n = 306)	P value
^aMissing data were observed for sex in 5 (1.1%) and 6 (2.0%) patients in the ad-CHF and dn-AHF groups, respectively (1.4% overall), and for LVEF in 46 (9.7%) and 9 (2.9%) patients, respectively (7.1% overall). _b Remaining etiologies not shown were grouped as ‘Other etiologies’ (ad-CHF: 49/474 [10.3%]; dn-AHF: 33/306 [10.8%]), including, for example, hypertrophic/restrictive cardiomyopathy, Chagas or viral cardiomyopathy, chemotherapy-related cardiotoxicity, and other causes. P < 0.05. IQR: interquartile range; ad-CHF: acute decompensated chronic heart failure; dn-AHF: de novo* acute heart failure; LVEF: left ventricular ejection fraction; HF: heart failure.
Age (median, IQR)	66.0 (56.0 - 76.0)	67.0 (55.0 - 79.0)	0.6
Male sex (n, %)^a	276 (58.8)	161 (53.7)	0.2
LVEF (median, IQR)^a	30.0 (20.0 - 45.0)	34.0 (25.0 - 45.0)	0.001*
Main HF etiologies ^b			0.002*
Ischemic (n, %)	142 (30.0)	115 (37.6)
Dilated (n, %)	103 (21.7)	31 (10.1)
Valvular (n, %)	70 (14.8)	40 (13.1)
Idiopathic (n, %)	50 (10.5)	48 (15.7)
Arrhythmic (n, %)	32 (6.8)	15 (4.9)
Hypertensive (n, %)	28 (5.9)	24 (7.8)

Table 1. Baseline Characteristics of the Study Population

Variable

Ad-CHF (n = 474)

Dn-AHF (n = 306)

P value

^aMissing data were observed for sex in 5 (1.1%) and 6 (2.0%) patients in the ad-CHF and dn-AHF groups, respectively (1.4% overall), and for LVEF in 46 (9.7%) and 9 (2.9%) patients, respectively (7.1% overall). _b Remaining etiologies not shown were grouped as ‘Other etiologies’ (ad-CHF: 49/474 [10.3%]; dn-AHF: 33/306 [10.8%]), including, for example, hypertrophic/restrictive cardiomyopathy, Chagas or viral cardiomyopathy, chemotherapy-related cardiotoxicity, and other causes. *P < 0.05. IQR: interquartile range; ad-CHF: acute decompensated chronic heart failure; dn-AHF: de novo acute heart failure; LVEF: left ventricular ejection fraction; HF: heart failure.

Age (median, IQR)

66.0 (56.0 - 76.0)

67.0 (55.0 - 79.0)

0.6

Male sex (n, %)^a

276 (58.8)

161 (53.7)

0.2

LVEF (median, IQR)^a

30.0 (20.0 - 45.0)

34.0 (25.0 - 45.0)

0.001*

Main HF etiologies ^b

0.002*

Ischemic (n, %)

142 (30.0)

115 (37.6)

Dilated (n, %)

103 (21.7)

31 (10.1)

Valvular (n, %)

70 (14.8)

40 (13.1)

Idiopathic (n, %)

50 (10.5)

48 (15.7)

Arrhythmic (n, %)

32 (6.8)

15 (4.9)

Hypertensive (n, %)

28 (5.9)

24 (7.8)

**Table 2.** Clinical, Hemodynamic and Biomarker Profile at Admission
Variable	Ad-CHF (n = 474)	Dn-AHF (n = 306)	P value
^aMissing data for New York Heart Association functional class at admission were recorded in 43 patients (9.1%) in the ad-CHF group and 38 patients (12.4%) in the dn-AHF group. P < 0.05. ACS: acute coronary syndrome; ad-CHF: acute decompensated chronic heart failure; AHF: acute heart failure; dn-AHF: de novo* acute heart failure; HF: heart failure; IQR: interquartile range; LVEF: left ventricular ejection fraction; NT-proBNP: N-terminal pro-B-type natriuretic peptide.
Clinical profile on admission			< 0.001*
Hypertensive AHF (n, %)	11 (2.3)	21 (6.9)
Pulmonary edema (n, %)	24 (5.1)	49 (16.0)
HF with acute decompensation (n, %)	359 (75.7)	116 (37.9)
Right-sided HF (n, %)	13 (2.7)	27 (8.8)
ACS with HF (n, %)	43 (9.1)	71 (23.2)
Cardiogenic shock (n, %)	24 (5.1)	22 (7.2)
Most prevalent signs/symptoms
Orthopnea (n, %)	196 (41.4)	94 (30.7)	0.003*
Chest pain (n, %)	122 (25.7)	123 (40.2)	< 0.001*
Nocturnal paroxysmal dyspnea (n, %)	143 (30.2)	60 (19.6)	0.001*
Jugular venous distention (n, %)	142 (30.0)	56 (18.3)	< 0.001*
Vital signs
Heart rate (median, IQR)	84.0 (71.0 - 99.0)	88.5 (77.2 - 103.8)	< 0.001*
Respiratory rate (median, IQR)	19.0 (18.0 - 22.0)	19.0 (18.0 - 22.0)	0.6
Systolic blood pressure (median, IQR)	120.0 (103.0 - 139.0)	128.0 (110.0 - 149.0)	< 0.001*
Mean arterial pressure (median, IQR)	73.0 (61.0 - 86.0)	76.0 (65.5 - 88.0)	0.010*
Oxygen saturation > 92% (n, %)	378 (80.8)	222 (74.7)	0.080
Functional class classification by the New York Heart Association^a			< 0.001*
Class I (n, %)	23 (5.3)	44 (16.4)
Class II (n, %)	90 (20.9)	88 (32.8)
Class III (n, %)	189 (43.9)	95 (35.4)
Class IV (n, %)	129 (29.9)	41 (15.3)
Hemodynamic profile (Stevenson’s classification)			< 0.001*
Stevenson A (n, %)	58 (12.2)	56 (18.3)
Stevenson B (n, %)	269 (56.8)	194 (63.4)
Stevenson C (n, %)	126 (26.6)	48 (15.7)
Stevenson L (n, %)	21 (4.4)	8 (2.6)
Laboratory values
Hemoglobin (g/dL) (median, IQR)	12.6 (10.7 - 14.2)	12.9 (11.3 - 14.4)	0.046*
Leukocytes (cells/µL) (median, IQR)	7,490 (5,830 - 10,105)	8,975 (6,837.5 - 11,700)	< 0.001*
Troponin I (ng/mL) (median, IQR)	23.1 (1.0 - 73.8)	47.0 (7.4 - 200)	< 0.001*
Creatinine (mg/dL) (median, IQR)	1.2 (0.9 - 1.6)	1.1 (0.9 - 1.4)	0.021*
NT-proBNP (pg/mL) (median, IQR)	4,151 (1,257 - 9,590.8)	3,309 (1,594.5 - 8,312.8)	0.6

Table 2. Clinical, Hemodynamic and Biomarker Profile at Admission

Variable

Ad-CHF (n = 474)

Dn-AHF (n = 306)

P value

^aMissing data for New York Heart Association functional class at admission were recorded in 43 patients (9.1%) in the ad-CHF group and 38 patients (12.4%) in the dn-AHF group. *P < 0.05. ACS: acute coronary syndrome; ad-CHF: acute decompensated chronic heart failure; AHF: acute heart failure; dn-AHF: de novo acute heart failure; HF: heart failure; IQR: interquartile range; LVEF: left ventricular ejection fraction; NT-proBNP: N-terminal pro-B-type natriuretic peptide.

Clinical profile on admission

< 0.001*

Hypertensive AHF (n, %)

11 (2.3)

21 (6.9)

Pulmonary edema (n, %)

24 (5.1)

49 (16.0)

HF with acute decompensation (n, %)

359 (75.7)

116 (37.9)

Right-sided HF (n, %)

13 (2.7)

27 (8.8)

ACS with HF (n, %)

43 (9.1)

71 (23.2)

Cardiogenic shock (n, %)

24 (5.1)

22 (7.2)

Most prevalent signs/symptoms

Orthopnea (n, %)

196 (41.4)

94 (30.7)

0.003*

Chest pain (n, %)

122 (25.7)

123 (40.2)

< 0.001*

Nocturnal paroxysmal dyspnea (n, %)

143 (30.2)

60 (19.6)

0.001*

Jugular venous distention (n, %)

142 (30.0)

56 (18.3)

< 0.001*

Vital signs

Heart rate (median, IQR)

84.0 (71.0 - 99.0)

88.5 (77.2 - 103.8)

< 0.001*

Respiratory rate (median, IQR)

19.0 (18.0 - 22.0)

0.6

Systolic blood pressure (median, IQR)

120.0 (103.0 - 139.0)

128.0 (110.0 - 149.0)

< 0.001*

Mean arterial pressure (median, IQR)

73.0 (61.0 - 86.0)

76.0 (65.5 - 88.0)

0.010*

Oxygen saturation > 92% (n, %)

378 (80.8)

222 (74.7)

0.080

Functional class classification by the New York Heart Association^a

< 0.001*

Class I (n, %)

23 (5.3)

44 (16.4)

Class II (n, %)

90 (20.9)

88 (32.8)

Class III (n, %)

189 (43.9)

95 (35.4)

Class IV (n, %)

129 (29.9)

41 (15.3)

Hemodynamic profile (Stevenson’s classification)

< 0.001*

Stevenson A (n, %)

58 (12.2)

56 (18.3)

Stevenson B (n, %)

269 (56.8)

194 (63.4)

Stevenson C (n, %)

126 (26.6)

48 (15.7)

Stevenson L (n, %)

21 (4.4)

8 (2.6)

Laboratory values

Hemoglobin (g/dL) (median, IQR)

12.6 (10.7 - 14.2)

12.9 (11.3 - 14.4)

0.046*

Leukocytes (cells/µL) (median, IQR)

7,490 (5,830 - 10,105)

8,975 (6,837.5 - 11,700)

< 0.001*

Troponin I (ng/mL) (median, IQR)

23.1 (1.0 - 73.8)

47.0 (7.4 - 200)

< 0.001*

Creatinine (mg/dL) (median, IQR)

1.2 (0.9 - 1.6)

1.1 (0.9 - 1.4)

0.021*

NT-proBNP (pg/mL) (median, IQR)

4,151 (1,257 - 9,590.8)

3,309 (1,594.5 - 8,312.8)

0.6

**Table 3.** In-Hospital Mortality Causes in Ad-CHF and Dn-AHF Groups
Variable	Ad-CHF (n = 25)^a	Dn-AHF (n = 25)^a	P value
^aOf the 30 patients who died in the dn-AHF group, cause-of-death information was unavailable for five (16.7%). In the ad-CHF group, cause-of-death information was unavailable for one patient (3.3%). HF: heart failure; ad-CHF: acute decompensated chronic heart failure; dn-AHF: de novo acute heart failure; MI: myocardial infarction.
Cause of death
Cardiovascular (n, %)	19 (76.0)	17 (68.0)	0.2
HF (n, %)	15 (60.0)	7 (28.0)
Sudden death (n, %)	3 (12.0)	7 (28.0)
MI (n, %)	0 (0.0)	1 (4.0)
Arrhythmia (n, %)	1 (4.0)	2 (8.0)
Non-cardiovascular n (%)	6 (24.0)	8 (32.0)	0.2
Infection (n, %)	1 (4.0)	4 (16.0)
Neoplasm (n, %)	1 (4.0)	1 (4.0)
Other (n, %)	4 (16.0)	3 (12.0)

Table 3. In-Hospital Mortality Causes in Ad-CHF and Dn-AHF Groups

Variable

Ad-CHF (n = 25)^a

Dn-AHF (n = 25)^a

P value

^aOf the 30 patients who died in the dn-AHF group, cause-of-death information was unavailable for five (16.7%). In the ad-CHF group, cause-of-death information was unavailable for one patient (3.3%). HF: heart failure; ad-CHF: acute decompensated chronic heart failure; dn-AHF: de novo acute heart failure; MI: myocardial infarction.

Cause of death

Cardiovascular (n, %)

19 (76.0)

17 (68.0)

0.2

HF (n, %)

15 (60.0)

7 (28.0)

Sudden death (n, %)

3 (12.0)

7 (28.0)

MI (n, %)

0 (0.0)

1 (4.0)

Arrhythmia (n, %)

1 (4.0)

2 (8.0)

Non-cardiovascular n (%)

6 (24.0)

8 (32.0)

0.2

Infection (n, %)

1 (4.0)

4 (16.0)

Neoplasm (n, %)

1 (4.0)

Other (n, %)

4 (16.0)

3 (12.0)