Prognostic Value of Multiple Electrocardiographic Abnormalities in Predicting Heart Failure Worsening and In-Hospital Mortality: A Prospective Observational Study

Background: Abnormalities of the electrocardiogram (ECG), which indicate underlying cardiac dysfunction, are known to be prognostic markers in heart failure (HF). Less is known about how several ECG abnormalities work together to affect HF outcomes. The aim of this study was to explore the relationship between various ECG anomalies and the prediction of in-hospital mortality and worsening of heart failure. Subjects and Methods: 100 HF patients who were admitted to Rizgary Teaching Hospital participated in our prospective observational study over one year. QRS prolongation, ST-segment deviations, left ventricular hypertrophy (LVH), atrial fibrillation (AF), and QT interval prolongation were all assessed on standard 12-lead ECGs. Patients were divided into three groups according to how many anomalies they had (0–1, 2, ≥3). In-hospital mortality and HF exacerbation were the primary outcomes. Results: 60% of patients were men, with average age of 65 ± 12 years. The most prevalent anomalies were ST-segment variations (40%), AF (32%), and QRS prolongation (35%). Worsening of HF was experienced in 20% of patients with 0–1 abnormality, 34% with 2 abnormalities, and 63% with ≥3 abnormalities (p<0.001). In-hospital death rates were 8%, 14%, and 38%, respectively (p<0.001). The most significant predictors of unfavorable outcomes were AF (HR: 1.8, p=0.002) and QT interval prolongation (HR: 1.9, p=0.001). Conclusion: Multiple ECG anomalies are a powerful, independent predictor of in-hospital mortality and the progression of heart failure. Risk assessment in HF care can be greatly enhanced by a comprehensive ECG study.