Short- and long-Term mortality in patients hospitalized for dyspnea with acute heart failure, respiratory infection, or both: insights from the PARADISE cohort

Background

Acute heart failure (AHF) and respiratory infections (RI) frequently coexist, with RI classically considered a major trigger for AHF decompensation. While these conditions can occur in isolation or combination, their distinct and cumulative impacts on short- and long-term survival remain insufficiently characterized.

Objectives

The aim of this study was to compare in-hospital and post-discharge mortality associated with AHF and RI, and to assess the prognostic impact of their coexistence.

Methods

We used data from the PARADISE retrospective cohort study to classify patients according to the discharge diagnosis of AHF and RI at the end of hospitalization. Multivariate logistic regression and Cox proportional hazards models were used to assess associations with in-hospital and post-discharge mortality, respectively.

Results

Among the 11,679 patients included in the study, 4,349 (37%) had AHF alone, 5,091 (44%) had RI alone, and 2,239 (19%) had concomitant AHF and RI. Overall mortality reached 73% in the combined group, compared with 68% for AHF alone and 60% for RI alone.

In-hospital mortality[1] was higher in patients with combined AHF and RI (22%) than in those with AHF alone (12%) or RI alone (13%) (p<0.001). After multivariable adjustment, the coexistence of AHF and RI was associated with higher in-hospital mortality compared with AHF alone (adjusted OR 1.54, 95% CI 1.19, 1.98). In contrast, no excess post-discharge mortality[2] was observed for the combined group compared with AHF alone (adjusted HR 1.00, 95% CI 0.92, 1.08). Patients with RI alone had a higher risk of death than those with AHF alone, both in-hospital (adjusted OR 1.30, 95% CI 1.10, 1.55) and after discharge (adjusted HR 1.17, 95% CI 1.08, 1.26).

Conclusion

Patients with concomitant acute heart failure and respiratory infection exhibit a dual risk pattern, behaving like respiratory infection during the in-hospital phase and like heart failure after discharge. This temporal shift underscores the need for heightened vigilance for infection during acute care, while long-term risk remains primarily driven by heart failure.In-hospital mortalityFor image description, please refer to the figure legend and surrounding text.Survival curve post-discharge mortalityFor image description, please refer to the figure legend and surrounding text.