Predictors of Rehospitalization in Patients with Acute Decompensated Heart Failure (ADHF)

Abstract

Background: Acute decompensated heart failure (ADHF) is a major cause of hospitalisation and is associated with frequent rehospitalisation, leading to increased morbidity, mortality, and healthcare costs. Early identification of patients at high risk of readmission is essential for improving outcomes.

Methods: This prospective observational study included 150 patients admitted with ADHF at a tertiary care hospital. Demographic characteristics, comorbidities, laboratory investigations, echocardiographic parameters, lung ultrasound findings, Venous Excess Ultrasound Score (VExUS), and discharge medications were recorded. Patients were followed for 180 days for rehospitalisation. Univariable and multivariable logistic regression analyses were performed to identify independent predictors.

Results: During follow-up, 45 patients (30.0%) experienced rehospitalisation. Rehospitalised patients were significantly older and had a higher prevalence of hypertension, diabetes mellitus, chronic kidney disease, and previous heart failure admission. They also had significantly higher serum creatinine, NT-proBNP, pulmonary artery systolic pressure, lung B-line score, and residual congestion, along with lower eGFR, serum sodium, LVEF, and TAPSE (all p<0.05). Multivariable analysis identified residual congestion at discharge (aOR 4.21), previous heart failure admission (aOR 3.06), hyponatraemia (aOR 2.72), NT-proBNP >7500 pg/mL (aOR 2.44), eGFR <60 mL/min/1.73 m² (aOR 2.18), and VExUS ≥2 (aOR 1.97) as independent predictors of rehospitalisation.

Conclusion: Residual congestion, previous heart failure admission, renal dysfunction, hyponatraemia, elevated NT-proBNP, and increased VExUS score independently predicted 180-day rehospitalisation in patients with ADHF. Early risk stratification and optimisation of discharge management may reduce recurrent hospitalisations.