Prior hospitalizations as a predictor of prognosis in heart failure with mildly reduced ejection fraction.

Abstract

Objective: This study aims to investigate the prognostic impact of the presence and type of prior hospitalizations in patients with heart failure with mildly reduced ejection fraction (HFmrEF).

Background: Data investigating the prognostic impact of the present and type of previous all-cause hospitalizations in HFmrEF is limited.

Methods: Consecutive patients hospitalized with HFmrEF at a single medical center were retrospectively included from 2016 to 2022. The prognosis of patients with a prior hospitalization < 12 months was compared to patients without. The primary endpoint was all-cause mortality at 30 months (median follow-up), the key secondary endpoint was heart failure (HF)-related rehospitalization at 30 months.

Results: Two thousand one hundred eighty four patients with HFmrEF were included, 34.8% had a previous hospitalization < 12 months (admission to internal medicine and geriatrics: 60.8%, surgical department: 23.5%). The presence of a previous hospitalization was associated with an increased risk of all-cause mortality (38.6% vs. 27.4%; HR = 1.51; 95% CI 1.30-1.76; p = 0.01) and HF-related rehospitalization at 30 months (21.2% vs. 9.1%; HR = 2.48; 95% CI 1.96-3.14; p = 0.01), even after multivariable adjustments. However, the department of previous hospitalization (internal medicine vs. surgical) did not significantly affect the risk of 30-months all-cause mortality (37.1% vs. 43.2%; HR = 0.82, 95% CI 0.63-1.08; p = 0.16) or HF-related rehospitalization (24.0% vs. 16.8%; HR = 1.47, 95% CI 0.98-2.24; p = 0.07). Finally, the type of previous admission (i.e., elective, emergency vs. HF-related admission) (log-rank p = 0.29) did not affect the risk of 30-months all-cause mortality.

Conclusion: Prior hospitalizations within 12 months were independently associated with impaired long-term mortality in patients with HFmrEF, irrespective of the department or type of prior admission.