Admission congestion phenotypes and 6-month outcomes after heart failure hospitalisation
I Moseley, A CorreaAbstract
Background
Residual congestion is a key determinant of outcomes in heart failure, yet congestion severity at hospital admission is variably defined and its prognostic relevance independent of renal dysfunction remains uncertain.
Purpose
To evaluate the association between admission congestion phenotypes and 6-month death or heart failure readmission after hospitalisation.
Methods
We analysed 1,959 hospitalised heart failure admissions from the MIMIC-IV database, a publicly available, de-identified electronic health record dataset with longitudinal follow-up. Congestion phenotypes were defined a priori using tertiles of admission brain natriuretic peptide (BNP): low, moderate, and severe congestion. The primary outcome was a composite of all-cause death or heart failure readmission within 6 months, with secondary analysis of each component. Multivariable logistic regression assessed associations between congestion phenotype and outcomes, adjusting for renal phenotype (creatinine tertiles), age group, sex, New York Heart Association functional class, Killip grade, and multi-class guideline-directed medical therapy (≥2 classes).
Results
The 6-month composite event rate was 40.9%. Event rates increased with congestion severity (low 39.8%, moderate 37.7%, severe 45.9%). Heart failure readmission accounted for the majority of events across congestion phenotypes, while the proportion of all-cause death increased stepwise with congestion severity. In unadjusted analyses, severe congestion was associated with increased 6-month risk (odds ratio 1.29, 95% confidence interval 1.06–1.56). After multivariable adjustment, congestion phenotype was no longer independently associated with outcomes (severe versus low adjusted odds ratio 1.00, 95% confidence interval 0.79–1.27), whereas renal dysfunction remained strongly predictive of both composite events and mortality.
Conclusion
Admission congestion severity is associated with higher unadjusted 6-month rates of death or heart failure readmission after hospitalisation, driven in part by increased mortality among patients with severe congestion. However, this association is attenuated after accounting for renal dysfunction and clinical severity, suggesting that renal phenotype may dominate medium-term risk stratification and supporting an integrated cardiorenal assessment in hospitalised heart failure.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.