[Determinants of short-term mortality in patients with heart failure in Hungary]

Introduction: Heart failure is one of the leading causes of death worldwide. Optimizing prognosis requires appropriate therapy. Administrative health databases enable large-scale assessments of clinical outcomes and pharmacological treatment patterns. Objective: This study aimed to examine short-term mortality and its associations with therapeutic strategies among patients diagnosed with heart failure. Method: We analyzed data from the Hungarian National Health Insurance Fund (NEAK) between 2012 and 2020. Patients were classified as having heart failure if they received an ICD-10 I50 code within two months following an echocardiography. Based on whether they were hospitalized within 60 days of diagnosis, patients were divided into two groups. Descriptive statistics were used to assess demographic characteristics, comorbidities, prescription medication use, and 90-day mortality rates. Multivariable analyses were conducted to evaluate the relationship between mortality and medication use. Results: More than 250,000 patients met the inclusion criteria. Female sex was associated with a 10% lower risk of short-term mortality, while patients aged 80–89 had more than a fivefold risk compared to those aged 40–49. Among outpatients who filled prescriptions for guideline-recommended medications prior to diagnosis, all therapeutic groups were associated with significantly reduced 90-day mortality. In contrast, longer hospital stays during the year preceding diagnosis were linked to a threefold increase in mortality. Compared to the reference county, certain regions exhibited up to 25% higher mortality risk. Discussion: The distribution of comorbidities and mortality rates was consistent with international findings. Our results suggest that heart failure management in Hungary is heterogeneous, with marked regional disparities in patient outcomes. Early initiation of evidence-based pharmacotherapy for high-risk comorbidities appears to reduce short-term mortality more effectively than post-diagnosis treatment alone. Conclusion: Retrospective administrative data can provide valuable insights into heart failure mortality, but results should be interpreted with caution. Our findings emphasize the importance of adherence to treatment guidelines and suggest that the potential benefits of pre-diagnostic use of guideline-recommended medications warrant further clinical investigation, alongside more detailed analyses to understand regional differences. Orv Hetil. 2025; 166(42): 1653–1665.