Causes and predictors of recurrent unplanned hospital admissions in heart failure patients: a cohort study: a comment.

We read with great interest the article authored by Kalter-Leibovici et al. Initial treatment in acute heart failure (AHF) is crucial in shaping short-term outcomes. Administered in the prehospital phase or emergency department (ED), early interventions-such as timing and dose of intravenous diuretics or vasodilators-may impact stabilization and decongestion. However, most predictive models, including the one discussed here, often omit these parameters, potentially missing an opportunity to refine risk stratification and anticipate complications.Beyond the ED, in-hospital treatment remains critical. The STRONG-HF trial demonstrated that intensifying medical therapy during hospitalization improves post-discharge outcomes, yet readmission rates remain high. This raises questions about the endpoint itself-whether it fully captures the benefits of optimized early care-or whether it reflects the inherent complexity of AHF as a progressive disease. Most ED-based studies focus on short- to mid-term readmissions (30-90 days), overlooking longer-term trajectories.Additionally, biomarkers such as NT-proBNP and renal function indicators, alongside advanced risk stratification tools, could enhance therapy guidance and discharge decisions. Yet, they remain underutilized in predictive models. Incorporating these parameters in future analyses may provide more actionable insights and improve long-term care strategies for AHF patients.