Cardiogeriatric Predictors of Early Adverse Outcomes After Heart Failure Hospitalisation in Older Adults: Insights from a Real-World Cohort Study (Elder-SAT)

BACKGROUND & AIM: Older patients hospitalised for heart failure (HF) remain at very high risk of early readmission and mortality. Frailty, multimorbidity and right-sided haemodynamic burden are frequent in this population, yet remain insufficiently integrated into post-discharge risk stratification and care pathways. The primary objective of this study was to identify cardiogeriatric and cardiopulmonary predictors of early adverse outcomes, defined as all-cause death or unplanned rehospitalisation within 90 days after hospital discharge (time zero defined as the date of discharge), in older adults with HF. METHODS: We conducted a real-world, single-centre retrospective cohort study including consecutive patients aged ≥65 years hospitalised for acute HF in a dedicated cardiogeriatric unit. All patients were discharged with structured follow-up combining comprehensive geriatric assessment and telemonitoring. RESULTS: Among 156 older adults (mean age 86 years; 51% women), 43 patients (27.6%) experienced an adverse event within 90 days, including 11 deaths (7.1%) and 32 unplanned rehospitalisations (20.5%). Cox regression analyses were performed for 124 patients with complete data. Elevated pulmonary arterial pressure emerged as an independent predictor of adverse outcomes (adjusted hazard ratio 2.56, 95% confidence interval 1.10-5.98). In contrast, left ventricular ejection fraction and classical geriatric markers were not associated with early events. A preserved metabolic profile was associated with lower rehospitalisation rates. Frailty-related variables were not independently associated with early outcomes. CONCLUSIONS: In older adults hospitalised for HF, early post-discharge outcomes appear driven primarily by haemodynamic and cardiopulmonary factors rather than frailty severity alone. These findings support a cardiogeriatric model integrating haemodynamic assessment, frailty-aware follow-up and structured post-discharge monitoring to improve early outcomes in ageing HF populations.