Impact of Immigration on Outcomes Following Acute Decompensated Heart Failure: A Retrospective Cohort Study

AIMS: The study aims to investigate the impact of immigration status on short- and long-term outcomes in patients hospitalized with acute decompensated heart failure (ADHF). METHODS: We conducted a retrospective cohort study at a single centre, analysing 7457 patients admitted for ADHF between 2007 and 2017, with follow-up until 2020 (mean 3.7 ± 3.5 years). Patients were categorized as immigrants (born abroad, 78.1%) or natives (born in Israel, 21.9%). Outcomes included in-hospital mortality, 30 day readmissions, 30 day mortality, 1 year mortality and 5 year all-cause mortality. Kaplan-Meier survival curves, a nonparametric analysis, were used to estimate survival probabilities across multiple timeframes while multivariable logistic and Cox regression analyses adjusted for key covariates such as age, sex and comorbidities. A stratified analysis compared outcomes between adulthood and early-life immigrants. RESULTS: Immigrants were older than natives (79.0 ± 10.1 vs. 70.8 ± 13.8 years, P < 0.001) and more likely to be female (53.2% vs. 45.0%, P < 0.001). Adjusted analyses revealed that immigration status was independently associated with higher 30 day [odds ration (OR) 1.37, 95% CI 1.12-1.67, P = 0.002], 1 year [hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.19-1.52, P < 0.001] and 5 year mortality (HR 1.20, 95% CI 1.12-1.29, P < 0.001). No significant associations were found for in-hospital mortality (OR 1.26, 95% CI 0.98-1.63, P = 0.07) or 30 day readmissions (OR 0.93, 95% CI 0.79-1.08, P = 0.31). Stratification by immigration age showed similar 5 year mortality between adulthood and early-life immigrants. CONCLUSIONS: Immigration status independently predicts worse short- and long-term outcomes in ADHF patients. The findings highlight the need for tailored healthcare policies to address disparities and improve outcomes in immigrant populations.