Clinical Characteristics and Profile of Heart Failure Patients at dr. Ramelan Navy Hospital in 2020

Background: Heart failure (HF) is a global pandemic affecting at least 26 million people worldwide and is increasing in prevalence. It has been associated with a high rate of readmissions and prolonged hospitalizations. There were few publications in Indonesia that described the characteristics and length of hospital stay of heart failure patients. Aims: To obtain data and describe the clinical characteristics and profile of heart failure patients hospitalized at dr. Ramelan Navy Hospital in 2020. Methods and Results : A cross sectional study was done using secondary data from patients’ medical records in dr. Ramelan Navy Hospital admitted during 2020. Data were then calculated and presented further. Based on the medical records, 121 heart failure patients were included in the study. Median age was 56 years old, 58,7% were men. Median length of stay was 6 days for all patients. 51.2% patients admitted to hospital with NYHA FC III. When patients were admitted to hospital, median systolic blood pressure was 124 mmHg and pulse was 91 beats per minute. Peripheral edema was shown in 67,8% of patients, hypertension in 49,6%, diabetes mellitus in 24,8%, ischemic heart disease in 52,9%. 6.6% of total patients treated in hospital died. Conclusion : Median length of stay for heart failure patients at dr. Ramelan Navy Hospital was 6 days. Most patients were men with median age of 56 years old.


Introduction
Life expectancy and survival after acute myocardial infarction are increasing. Advances in treatment are one of the reasons for the increasing number of patients living and progressing to chronic heart failure. As a result, the number of hospitalizations due to heart failure also increased. Heart failure (HF) affects 6% to 10% of people over the age of 65 years. Although the relative incidence is lower in women than in men [2] . HF has been defined as global pandemic, since it affects around 26 million people worldwide 1 . In 2012 it was responsible for an estimated health expenditure of around $31 billion, equivalent to more than 10 % of the total health expenditure for cardiovascular diseases in the United States (US) [3] . There are over 1 million hospitalizations with a primary diagnosis of HF each year in the U.S., and HF is the most common diagnosis for hospital admissions in patients above 65 years of age [4] .  [5] . Heart failure is often associated with a high frequency of hospitalization and a long length of stay. This contributes to a significant increase in resource use [6] . Therefore, the length of stay of heart failure patients needs special attention. The average length of stay in hospital (ALOS) is often used as an indicator of treatment efficiency. The median length of stay was defined as the average number of days a patient was hospitalized [7] . The length of stay of heart failure patients varies widely in various countries with a range between 4 -21 days [8][9][10] .

ARTICLE INFO
Data on the length of stay of patients with heart failure is very important considering that hospitalization has a direct impact on the patient's quality of life, the risk of future events, as well as a significant contribution to the large costs of treatment [8] .
Bueno et al observational study also stated that the decrease in length of stay and mortality in hospital were observed over a period of 14 years (1993-2006), there was an increase in readmission and 30-day mortality rate after discharge [10] . Therefore, the indication of hospitalization for patients with heart failure and the best time to discharge patients must still consider aspects of patient safety, cost savings, and losses due to lengthening the length of stay (such as nosocomial infections and deteriorating physical conditions) [9] .
To study these things, accurate data are needed regarding the average length of stay in the hospital, demographic characteristics, and clinical characteristics of these heart failure patients. The data then used as a benchmark for the development of an excellent service system for heart failure patients. This study will describe descriptively the average length of stay for heart failure patients at dr. Ramelan Navy Hospital along with the demographic and clinical characteristics of these patients in 2020.

Methods
The study population was heart failure patients.

Demographic Characteristics
In this study, the largest proportion was found in men (58.7%). This is similar to studies in several other centers abroad. A prospective cohort study in Japan, Kajimoto et al. also stated that the proportion of men with congestive heart failure in the Acute Decompensated Heart Failure Syndromes Registry in Japan reached 58% [11] .
Wright et al found that the proportion of men treated with heart failure in New Zealand was 60% [6] . greatly between the patients who were the subjects of this study, ranging from shock to hypertensive emergency or urgency. Singh and Gupta (2005) also found that systolic blood pressure at the start of treatment was 139 ± 20 mmHg in South Asian patients [12] .
The initial heart rate at the start of treatment was not significantly different between this study (91 beats/minute) and previous studies  [6,9] . In this study also found that peripheral edema seen in 67.8% of patients.

 Treatment Indicator
The length of stay for heart failure patients varies greatly from one study to another.
In this study, the median length of stay for heart failure patients at dr. Ramelan Navy Hospital during 2020 was 6 days.  [18] . This indicates that the mortality rate of heart failure patients at dr.
Ramelan Navy Hospital in 2020 is lower than the mortality rate of heart failure patients treated in the United States in 2005-2008.
However, this could be due to patients who do not return regularly for follow-up resulting in not being recorded by the hospital medical records.

Conclusion
Based on this study, it was found that the median length of stay for heart failure patients at dr.
Ramelan Navy Hospital in 2020 was 8 days. The cut-off value of the length of stay for patients with heart failure needs to be determined to be an operational limitation for further research and as an indicator of the success of services in hospitals.
Several other studies can be planned to learn more