The role of BAN-ADHF score for long term prognosis in acute heart failure with preserved ejection fraction

Introduction Acute heart failure with preserved ejection fraction (HFpEF) constitutes a growing proportion of heart failure hospitalizations, yet reliable prognostic tools for this complex phenotype remain limited. The recently developed BAN-ADHF score, derived from routine clinical and laboratory data, has been validated as a short-term predictor in acute heart failure setting, but its value for long-term prognosis has not been explored. (1,2) This study aimed to assess the prognostic value of the BAN-ADHF score for 5-year all-cause mortality in patients admitted with acute HFpEF. Methods and Results A total of 143 consecutive patients (64% female, mean age 73.9 years) hospitalized for acute HFpEF were analyzed. Follow-up period was 5 years and data were available for 111 patients. According to the BAN-ADHF classification, patients were categorized as low-risk (<12 BAN-ADHF score) and high-risk (≥12 BAN-ADHF score). A total of 58 patients (52.3%) died during follow-up. Mortality was markedly higher among high-risk patients (92.3%) compared with low-risk individuals (58.1%; p<0.001). When evaluated as a continuous variable, the BAN-ADHF score was significantly associated with mortality (OR≈1.10 per unit, p<0.001). Using the predefined threshold of ≥12, high-risk patients had an approximately 3.8-fold higher risk of death (95% CI 1.8–8.0, p=0.001). In multivariable logistic regression adjusted for age, admission NYHA class, log(NT-proBNP), GFR, hemoglobin level and log(CRP), BAN-ADHF remained independent predictor of long-term mortality (95% CI 1.02-1.44, p=0.0251). Conclusion The BAN-ADHF score identified patients with acute HFpEF at risk of long-term mortality. Individuals classified as high-risk (BAN-ADHF ≥ 12) experienced a nearly fourfold increase in five-year mortality compared with those in the low-risk group. In multivariable analysis BAN-ADHF retained its independent prognostic significance. These results highlight the score’s value as a tool for early risk stratification in acute HFpEF.