Prognostic Value of Early Rehospitalization in Heart Failure Patients

Background: Acute heart failure (AHF) is a common cause of hospital admission with high morbidity and mortality. Up to one-third of AHF patients require rehospitalization during the first three months after discharge due to the nature of disease and the patient's characteristics. In this regard, the first 3 months after an episode of decompensation of heart failure are called the "vulnerable" period. However, there is a gap in knowledge about the significance of this rehospitalization on heart failure course. The aim of the study is to evaluate impact on mortality of AHF rehospitalization during 3 months after hospital discharge on a retrospective registry with 3 year follow-up. Methods: Patients after AHF hospitalization episode between 1 December 2020 and 30 November 2023 were monitored via electronical medical records for 3 year follow-up. All patients who survived after index hospitalization were included. The primary endpoint was all-cause mortality. COX-multiple regression was used to evaluate the impact of rehospitalization during 90 days after index discharge on outcomes. p values less than 0.05 were considered to be significant. Results: A cohort of 204 patients, 56.6% males, with an average age of 72 ± 13 years, were included in the study with medium follow-up of 22 ± 12 months. Within 3 months after discharge, 55 (27%) patients were rehospitalized for AHF, and 11 (5%) patients died. Patients who experienced a recurrent episode of AHF were characterized by a history of previous hospitalizations for AHF before inclusion (39 (71%) vs. 72 (48%); p = 0.005), the use of intravenous inotropic drugs (5 (9%) vs. 2 (1%); p = 0.007), higher initial doses of furosemide during index hospitalization (98 ± 46 vs. 82 ± 37; p = 0.01), and higher doses of furosemide at discharge (54 ± 41; 41 ± 33; p = 0.02). Left ventricular ejection fraction (LVEF), prevalence of atrial fibrillation (AF), diabetes mellitus (DM), and chronic kidney disease (CKD) did not differ between the groups. Over 3 years follow-up, 68 (33.2%) patients died, and cardiovascular mortality was 15.6% (32 patients). In multivariate COX-regression age (HR 1.04 [1.008-1.07]), heart rate (HR) on admission (HR 1.02 [1.004-1.03]), and hospitalization within the first 3 months after discharge were independent predictors of death (HR 2.21 [1.32-3.83]). Conclusions: Readmission for AHF within the first 3 months after discharge is an independent risk factor for all-cause cardiovascular mortality during 3 years follow-up.