Serum Hemoglobin-to-Creatinine Ratio and Post-Discharge Readmission or Mortality in Older Patients With Heart...

Older patients with heart failure (HF) experience poor prognoses after hospital discharge, underscoring the importance of risk stratification for improving out-of-hospital management. Therefore, this study aimed to investigate the association between a composite index of anemia and renal impairment, defined as the serum hemoglobin-to-creatinine ratio (HCR), and post-discharge readmission or mortality in older patients with HF.

Data were obtained from the Zigong Fourth People's Hospital. HF was diagnosed in accordance with the 2016 European Society of Cardiology guidelines. The HCR was employed, while the outcome was a composite of readmission or mortality assessed at 180 and 90 days after discharge. The association between the HCR and outcomes was analyzed using Cox proportional hazards models, with robustness evaluated through subgroup and sensitivity analyses.

The study cohort included 1781 older patients (age ≥60 years) with HF, of whom 41.6% experienced readmission or mortality within 180 days after discharge. Multivariable Cox regression indicated that a higher HCR was associated with a lower risk of 180-day readmission or mortality (hazard ratio (HR) = 0.76; 95% confidence interval (CI): 0.67-0.87). When analyzed using the HCR tertiles, the middle and highest tertiles exhibited progressively reduced risks (HR = 0.74, 95% CI: 0.61-0.88 and HR = 0.58, 95% CI: 0.47-0.71), respectively; p for trend < 0.001) compared with the lowest tertile. Similar associations were observed for the 90-day composite outcome. The stability of these associations was confirmed through subgroup and sensitivity analyses.

A higher HCR is independently associated with a reduced risk of readmission or mortality within 180 days of discharge in older patients with HF. The HCR may serve as a useful prognostic marker for risk stratification in this population.