Predictors of long-term survival in patients with a first episode of acute heart failure

Acute heart failure (AHF) represents a critical event in heart failure progression, but data on long-term outcomes after first hospitalization remain scarce. The aim is to describe long-term survival and evaluate its predictors after the first episode of AHF.

Patients from five Spanish hospitals with a confirmed first diagnosis of AHF were categorized based on survival (≥5 or <5 years). Thirteen independent variables were identified. Mortality was assessed using Kaplan-Meier curves after up to 10 years of follow-up. Adjusted odds ratios (OR) with 95% confidence intervals (CI) for mortality were calculated. Additionally, adjusted survival probabilities according to patient age and left ventricular ejection fraction (LVEF) were obtained using restricted cubic splines.

A total of 1986 patients were included, with a median age 76 years (range: 68-82), 50% women, and 57% with preserved LVEF. Five-year mortality was 52%. Adjusted analysis showed that age (OR, 0.470 per 10-year increment; 95% CI, 0.421-0.525), New York Heart Association class III-IV vs. I (OR, 0.476; 95% CI, 0.341-0.666) and II vs. I (OR, 0.780; 95% CI, 0.627-0.969), chronic kidney disease (OR, 0.609; 95% CI, 0.452-0.820), coronary artery disease (OR, 0.657; 95% CI, 0.523-0.824), diabetes mellitus (OR, 0.658; 95% CI, 0.534-0.811), and male sex (OR, 0.774; 95% CI, 0.625-0.958) were associated with death within 5 years. LVEF at inclusion was not related to 5-year survival.

Survival after a first AHF episode is poor, with age, New York Heart Association class, kidney function, coronary artery disease, diabetes, and sex being key predictors of long-term mortality.