Applicable Strategies Against Acute Decompensated Heart Failure Patients According to Time of Hospitalization

Background: Heart failure (HF) is growing global issue, especially among older adults, and patients can be hospitalized at any time of day. We compared patients' characteristics, including precipitating factors leading to HF hospitalization, between daytime and nighttime admissions. Methods and results: A total of 1,124 patients, who were primarily admitted with a diagnosis of acute decompensated HF were enrolled. Patients were divided according to time of hospitalization into daytime (n=770; 8 am-6 pm) and nighttime (n=354; 6 pm-8 am) groups. The prevalence of hypertension, new-onset HF, and clinical scenario 1 [systolic blood pressure (BP) at admission >= 140 mmHg], frequency of New York Heart Association class IV symptoms, systolic and diastolic BP, heart rate, estimated glomerular filtration rate (eGFR), serum concentrations of albumin and hemoglobin, and treatment with vasodilators and noninvasive ventilation were greater, while the prevalence of atrial fibrillation, duration of persistent HF symptoms >= 24 h, serum concentration of total bilirubin, loop diuretic use and mineralocorticoid antagonist use before admission were lower in the nighttime group. Among the HF-precipitating factors, nonadherence was the most prevalent in both the daytime (32.2%) and nighttime (29.9%) groups. Poorly controlled hypertension was common in nighttime patients (10.5% vs. 5.1% P<0.001). Conclusions: Prehospital BP control may contribute to preventing nighttime hospitalizations. Additionally, the most essential step in preventing hospitalizations due to HF, day or night, is patient education and disease management.