A mortality risk stratification model for patients with acute heart failure

Abstract Introduction Heart failure is associated with high rates of morbidity and mortality. The prognosis for these patients is poor, which makes the reliable assessment of mortality risk crucial. Purpose The purpose of this study is to identify the clinical and biochemical factors associated with mortality. Materials and Method This is a retrospective observational study that included patients diagnosed with heart failure (NYHA Class III-IV) who had been hospitalized at least once from January 1, 2022, to December 31, 2022, due to newly diagnosed heart failure or a worsening of the functional stage of pre-existing heart failure. Results The total sample included 647 patients, with a mean age of 73±13.7 years, of whom 33.5% were women. During the two-year follow-up period, 296 deaths were recorded, corresponding to an overall mortality rate of 45.74%. Of these deaths, 207 were men (69.9%) and 89 were women (30.1%). Among the deceased patients, 56.52% had undergone cardiac catheterization during their hospitalization, while 45% had undergone percutaneous coronary intervention (angioplasty). In 51% of the cases, death was related to ischemic heart disease. Among patients with significant valvular disease, the mortality rate was 55%, whereas the corresponding rate in patients with congenital heart disease was 42%. Of the deceased patients who had an implantable device (e.g., ICD), 40% had experienced at least one shock episode prior to their hospital admission. The presence of a transcatheter aortic valve implantation (TAVI) was associated with a trend towards a reduced risk of death; however, this association did not reach statistical significance (Pearson chi²(1)=3.3188, p=0.068). Conversely, in-hospital ultrafiltration did not appear to affect survival (Pearson chi²(1)=0.0075, p=0.931). Additionally, a lack of change in NT-proBNP levels, the lymphocyte percentage (p=0.0004), and LDL-cholesterol levels (p=0.04) showed a statistically significant correlation with mortality. In contrast, admission and discharge biochemical markers (such as urea, creatinine, sodium, hemoglobin, and uric acid) did not have a statistically significant effect on patient survival. Conclusions This study highlighted the particularly poor prognosis of patients with advanced heart failure, with an overall mortality rate exceeding 45% within a two-year follow-up period. Ischemic etiology, the presence of significant valvular disease, and congenital heart disease were associated with increased mortality rates, identifying these as high-risk groups. Of interest was the statistically significant association of stable NT-proBNP values, lymphocyte percentage, and LDL-cholesterol levels with mortality. These findings underscore the need for adopting appropriate prognostic markers in populations with end-stage heart failure to select interventions that can improve long-term prognosis.