Admission cardiorenal determinants of mid-term outcomes in acute heart failure

Background

Acute heart failure (AHF) is associated with a high burden of early and mid-term adverse outcomes, largely driven by the interaction between hemodynamic factors, renal dysfunction and systemic illness. Identification of simple cardiorenal predictors at hospital admission may facilitate early risk stratification and guide post-discharge management.

Methods

We analyzed a single-center registry of consecutive patients hospitalized with AHF. A hierarchical composite endpoint of all-cause mortality, need for renal replacement therapy (RRT), or AHF rehospitalization at 6 months was constructed, prioritizing death and RRT. Patients receiving chronic RRT and those with incomplete data were excluded. Baseline clinical, laboratory, and echocardiographic characteristics were compared between patients with and without the composite endpoint. Multivalvular heart disease was defined as the coexistence of ≥2 valve lesions of at least moderate severity (stenosis and/or regurgitation) on transthoracic echocardiography. Multivariable logistic regression analysis was performed to identify independent predictors of the composite outcome.

Results

Among 407 patients (median age 80 years, 54% male), 151 (37.1%) experienced the composite endpoint during 6-month follow-up. Compared with event-free patients, those experiencing the composite endpoint were older and more frequently presented with advanced functional class, lower systolic blood pressure at admission, impaired renal function, and higher markers of congestion and inflammation. They also had lower hemoglobin and albumin levels, reflecting a greater burden of systemic vulnerability. Structural heart disease was more prevalent, including multivalvular heart disease and right-sided heart failure.

In multivariable analysis, lower systolic blood pressure at admission (OR 0.99 per mmHg; 95% CI 0.98–1.00; p = 0.004), lower estimated glomerular filtration rate at presentation (OR 0.98 per ml/min/1.73 m²; 95% CI 0.97–0.99; p < 0.001), and the presence of multivalvular heart disease (OR 0.61; 95% CI 0.38–0.99; p = 0.046) were independently associated with the composite endpoint.

Conclusions

In patients hospitalized with AHF, readily available admission parameters reflecting the cardiorenal axis—particularly systolic blood pressure and renal function—together with advanced valvular heart disease, are independent predictors of adverse mid-term outcomes. Early identification of high-risk cardiorenal phenotypes may support individualized follow-up strategies and closer post-discharge surveillance.Demographics and characteristicsFor image description, please refer to the figure legend and surrounding text.Labs and echocardiographic parametersFor image description, please refer to the figure legend and surrounding text.