Clinical profile, guideline-directed therapy uptake, and in-hospital mortality in acute heart failure at a public teaching hospital in southwestern Colombia: a single-centre retrospective registry (EVARISTO-AHF)

Heart failure is a condition where the heart muscle becomes too weak or too stiff to pump blood effectively to the rest of the body. It is not a single disease but rather the final stage of many different heart problems, from high blood pressure to damaged heart valves. When the heart cannot keep up, fluid backs up into the lungs and legs, causing shortness of breath and swelling. This state often leads to sudden, severe episodes that require emergency hospital care. While doctors have developed a standard set of powerful medications to manage this condition, most of the evidence for how these drugs work comes from wealthy nations in North America and Europe. In many parts of the world, particularly in public hospitals serving lower-income populations, it remains unclear how these treatments are actually used and whether patients receive the same level of care. Understanding the real-world experience of patients in these settings is crucial, because the people who need these medicines the most are often the ones least likely to be included in major medical studies.

In southwestern Colombia, researchers at a large public teaching hospital set out to fill this gap by creating a detailed record of patients admitted with acute heart failure. This hospital, known as Hospital Universitario del Valle Evaristo García, serves as a primary referral center for five different departments in the region, caring for a population that is largely covered by subsidized government health insurance. The team, led by cardiologists and internal medicine specialists, looked back at the medical records of 251 consecutive adults who were hospitalized for heart failure between June 2022 and October 2024. They focused on patients who stayed in the hospital for more than two days, ensuring they had enough time to be fully evaluated and treated. The researchers gathered information on who these patients were, what other health problems they had, how severe their heart failure was, and most importantly, what medicines they were given when they arrived and what they were sent home with.

The group of patients studied reflected the specific demographics of the region. The median age was 70 years, and nearly 60 percent were men. A significant portion of the group, about 15 percent, identified as Afro-descendant, a demographic that has historically been underrepresented in heart failure research. Most of the patients, roughly 77 percent, were enrolled in the subsidized health insurance regime, which is distinct from the contributive insurance held by those with formal employment. The most common underlying health issues among these patients were high blood pressure, which affected nearly three-quarters of the group, followed by diabetes and coronary artery disease. When they arrived at the hospital, the majority were in a state of fluid overload but still had warm skin and adequate blood flow to their extremities, a clinical picture that doctors describe as "wet and warm." This specific profile was the most common presentation, appearing in nearly 80 percent of the cases.

The study revealed that the severity of heart failure varied among the patients. About 62 percent had a heart that was significantly weakened, with a pumping function below 40 percent, while the rest had hearts that were either mildly weakened or preserved in function. Despite these differences, the outcome for the group as a whole was sobering. The hospital stay lasted a median of 13 days, and during that time, 6.8 percent of the patients died. The leading causes of death were heart failure that could not be controlled, infections, and irregular heart rhythms. Notably, the death rate did not differ significantly between those with severely weakened hearts and those with preserved heart function, suggesting that the severity of the acute episode and the presence of complications like infection were the driving factors for mortality in this setting.

Perhaps the most encouraging finding of the study concerned the treatment patients received. When the patients first arrived at the hospital, fewer than half were taking the standard, life-prolonging medications recommended by global medical guidelines. However, by the time they were discharged, the situation had changed dramatically. Among the patients who survived their hospital stay, the use of beta-blockers, which slow the heart rate and reduce its workload, rose to over 90 percent. The use of medications that block the body's stress hormones, known as renin–angiotensin–aldosterone system inhibitors, increased to nearly 83 percent. Most striking was the uptake of a newer class of drugs called SGLT-2 inhibitors, which were originally developed for diabetes but have proven highly effective for heart failure. At admission, only about one in five patients was taking this medication, but by discharge, that number had jumped to 76 percent. This represents a substantial improvement in care, showing that even in a resource-limited public hospital, doctors are successfully adopting modern, evidence-based treatments.

Despite this overall progress, the researchers identified a specific area where care could still be improved. While the new heart failure medications were prescribed frequently, there was a noticeable gap based on the strength of the heart muscle. Patients with severely weakened hearts were much more likely to be sent home with SGLT-2 inhibitors than those with hearts that were still pumping normally. This difference is significant because medical guidelines now recommend these drugs for all types of heart failure, regardless of how weak the heart is. The fact that doctors were prescribing them less often for patients with preserved heart function suggests a lag in adopting the newest evidence for this specific group, rather than a lack of access to the drugs themselves, as these medications are covered by the national health plan.

This study provides a rare and valuable glimpse into the reality of heart failure care in a public teaching hospital in Latin America. It confirms that the patients treated here are often older, poorer, and more likely to be from Afro-descendant communities than those in previous studies from the region. It also demonstrates that the medical team at this hospital is capable of delivering high-quality, guideline-directed care, successfully transitioning the vast majority of survivors onto the most effective modern therapies before they leave the hospital. The work highlights that while the system is working well in many ways, there is still a specific opportunity to ensure that every patient, regardless of their heart's pumping strength, receives the full benefit of the latest medical advances. By documenting these patterns, the researchers have created a roadmap for improving care, showing that the path forward involves not just providing access to medicine, but also ensuring that the newest knowledge reaches every corner of the patient population.