Short- and Long-Term Mortality in Patients Hospitalized for Dyspnoea with Acute Heart Failure, Respiratory Infection, or Both: Insights from the PARADISE Cohort

BACKGROUND: Acute heart failure (AHF) and respiratory infection (RI) frequently coexist, with the latter commonly regarded as a trigger of AHF decompensation. However, the independent and combined prognostic impact of these conditions on survival is not well studied. We therefore assessed the association of AHF and RI, both separately and in combination, with subsequent mortality. METHODS: Patients discharged with diagnoses of AHF, RI, or both were identified from the PARADISE study, a large cohort of patients hospitalised for acute dyspnoea. Associations with in-hospital and post-discharge mortality were assessed using multivariable binomial logistic regression and Cox proportional hazards models, respectively. RESULTS: Among 11,679 patients, 4,349 (37%) had AHF alone, 5,091 (44%) had RI alone, and 2,239 (19%) had both AHF and RI. In-hospital mortality was highest in patients with concomitant AHF and RI (21.9%), whereas post-discharge mortality was highest among those with AHF (55.2%). After multivariable adjustment, the coexistence of AHF and RI was associated with higher in-hospital mortality compared with AHF alone (adjusted OR [aOR]: 1.62, 1.33-1.98, P<0.001), but not with higher post-discharge mortality (adjusted HR [aHR]: 0.99, 0.88-1.11, P=0.9). Compared with AHF alone, RI alone was not associated with a higher risk of death both during hospitalization (aOR 1.11, 0.89-1.39, P=0.3) and after discharge (aHR 1.07, 0.97-1.17, P=0.2). Results from sensitivity analyses including natriuretic peptides confirm those results. CONCLUSION: Patients with concomitant AHF and RI showed an increased in-hospital risk but no excess post-discharge risk compared with AHF alone, whereas RI alone is not associated with increased mortality both in-hospital and post-discharge.