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Prior Hospitalizations as a Predictor of Prognosis in Heart Failure with Mildly Reduced Ejection Fraction

https://doi.org/10.1007/s00392-025-02625-4

Henning Johann Steffen (Mannheim)1, M. Behnes (Mannheim)1, A. Schmitt (Mannheim)1, N. Abel (Mannheim)1, F. Lau (Mannheim)1, M. Reinhardt (Mannheim)1, M. Akin (Bochum)2, T. Bertsch (Nürnberg)3, M. Ayoub (Bad Oeynhausen)4, K. A. Mashayekhi (Lahr/Schwarzwald)5, K. J. Weidner (Mannheim)1, I. Akin (Mannheim)1, T. Schupp (Mannheim)1

1Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; 2Kath. Klinikum Bochum Kardiologie und Rhytmologie Bochum, Deutschland; 3Klinikum Nürnberg Nord Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin Nürnberg, Deutschland; 4Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 5MediClin Herzzentrum Lahr/Baden Innere Medizin und Kardiologie Lahr/Schwarzwald, Deutschland

 

Objective: This study aims to clarify 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 are 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 HF-related rehospitalization at 30 months.

Results: 2,184 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 rehospitalizations 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 versus 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 versus 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.

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