Long-term burden of heart failure: a population-based cohort study on mortality and rehospitalizations

Heart failure (HF) is a prevalent, progressive syndrome, and a leading cause of hospitalization, mortality, and healthcare expenditure worldwide, especially among older adults. This study aimed to assess the long-term burden of mortality, rehospitalizations and their composite among HF patients and to identify independent predictors of these outcomes. A population-based retrospective cohort study was conducted across all hospitals in the province of L'Aquila, Italy, including all residents discharged alive after an index HF hospitalization between 1 January 2014 and 31 December 2022, with follow-up through 31 December 2023. Kaplan-Meier analysis estimated event rates at 30 days, 90 days, 1 year, 5 years and 9 years. Predictors of the 5-year composite outcome (death or rehospitalization) and rehospitalization frequency were analyzed using multivariable Cox regression and negative binomial models. A total of 5,883 patients were included. By 5 years, 69.4% had experienced the composite outcome, increasing to 85.4% by 9 years. Nearly half of the rehospitalizations occurred in the first year. Older age, male sex, longer initial hospital stay, and earlier discharge year were associated with poorer outcomes. HF poses a long-term burden, highlighting the need for ongoing care, in which nurses are central to improve outcomes and care quality.