Heart Failure Is Associated with Limb-Related Adverse Events in Patients Hospitalized for Diabetic Foot Ulcers

Objectives: To evaluate the impact of heart failure (HF) on one-year outcomes in patients hospitalized for diabetic foot ulcers (DFUs). Methods: A retrospective observational study including consecutive patients admitted in 2024 to a tertiary multidisciplinary diabetic foot service for DFUs. Patients were stratified according to the presence of HF (HF+ vs. HF-). One-year outcomes included wound healing, major amputation, non-fatal major adverse limb events (NF-MALCE), including myocardial infarction, stroke, recurrent chronic limb-threatening ischaemia (CLTI) requiring revascularization, and mortality. Results: Overall, 270 patients were included (104 HF+ [38.5%] vs. 166 HF- [61.5%]). Patients with HF exhibited a more severe cardiorenal phenotype, with worse cardiac and renal biomarkers. At one-year follow-up, patients with HF showed lower wound healing rates than patients without HF (58.6% vs. 71.7%, p = 0.03), higher incidence of NF-MALCE (43.3% vs. 18.7%, p < 0.001), mainly driven by recurrent CLTI requiring revascularization (48.9% vs. 27.0%, p < 0.001), and higher mortality (21.1% vs. 7.2%, p = 0.001). Conversely, no differences were observed in major amputation, myocardial infarction, or stroke. After multivariable adjustment for age, sex, ischaemic heart disease, atrial fibrillation, dialysis, haemoglobin, albumin, foot infection and peripheral arterial disease (PAD), HF remained independently associated with NF-MALCE (adjusted odds ratio (aOR) 2.90, 95% confidence interval (CI) 1.38-6.09, p = 0.005) and recurrent CLTI requiring revascularization (aOR 2.43, 95% CI 1.11-5.32, p = 0.026); the association remained consistent in the subgroup with PAD. Conclusions: HF identifies a high-risk cardio-renal phenotype and is independently associated with increased limb-related adverse events in patients hospitalized for DFUs, supporting closer vascular surveillance and integrated multidisciplinary cardio-renal-foot care.