Determinants of recurrent hospitalization in acute heart failure: prognostic role of systolic dysfunction and renal impairment
E Chuquiure-Valenzuela, A Perez-Falcon, M Tapia-Sansores, K Bautista-Hernandez, A Mendoza-Cortez, G Martinez-Gonzalez, R Garduno-Correa, F Bejarano-Vergara, F Gonzalez-Mayo, M Chuquiure-Gil, R Lozano-Corral, V Flores-GutierrezAbstract
Background
To identify independent clinical predictors of short- (30-day) and mid-term (365-day) hospital readmission in patients with acute heart failure (AHF).
Material and Method
A prospective, observational cohort study was conducted including adult patients hospitalized for AHF between August 2022 and July 2023. Sociodemographic, clinical, and biochemical variables were collected, including left ventricular ejection fraction (LVEF), renal function, and New York Heart Association (NYHA) functional class. The primary outcome was hospital readmission for AHF at 30 and 365 days. Independent predictors were identified using multivariable Cox proportional hazards models adjusted for clinically relevant covariates. Results are reported as hazard ratios (HR) with 95% confidence intervals (95% CI). Statistical significance was defined as p<0.05.
Results
A total of 878 patients were included. One-year readmission rates were significantly higher in patients with LVEF <40% compared with those with LVEF ≥40% (35% vs 15%; p<0.001). In the multivariable 30-day model, a prior diagnosis of heart failure was independently associated with an increased risk of readmission (HR 6.85; 95% CI 4.10–11.45; p<0.001), as was severe renal dysfunction (estimated glomerular filtration rate <30 mL/min/1.73 m²; HR 5.80; 95% CI 2.90–11.60; p<0.001). Atrial fibrillation and valvular heart disease were associated with a lower risk of early readmission (HR 0.50; 95% CI 0.30–0.85; p<0.05). At 365 days, the combination of LVEF <40% and NYHA class IV was an independent predictor of readmission (HR 6.98; 95% CI 3.90–12.40; p<0.001), whereas age >75 years, female sex, and NYHA class I were associated with reduced risk (HR ≈0.50; p<0.05).
Conclusions
In patients with AHF, severe systolic dysfunction, prior heart failure, and advanced renal impairment are robust independent predictors of hospital readmission, enabling improved post-discharge risk stratification and targeted follow-up strategies.