Early clues to long-term outcomes: predicting 180-day mortality in acute heart failure

Background Acute heart failure (AHF) is associated with substantial post-discharge mortality despite advances in therapy. Early identification of high-risk patients is essential to guide follow-up and treatment optimization. Purpose To determine early clinical, laboratory, echocardiographic and treatment-related predictors of 180-day mortality among patients hospitalized with AHF. Materials-Methods This prospective single-center study included consecutive patients admitted with AHF between February 2023 and January 2025. Demographics, comorbidities, admission laboratory parameters (NT-proBNP, creatinine, urea, estimated glomerular filtration rate [eGFR], high-sensitivity troponin-I [hs-cTnI]), hemodynamic parameters, echocardiographic indices (left ventricular ejection fraction [LVEF], E/E′ ratio, tricuspid annular systolic velocity [S′], pulmonary artery systolic pressure [PASP], valvular disease), and discharge heart failure (HF) medication were collected. Patients with in-hospital death, incomplete data, or chronic renal replacement therapy were excluded. The primary endpoint was 180-day post-discharge mortality. Results Among 413 patients, 59 (14.3%) died within 180 days. In univariate analyses, predictors of mortality included older age, chronic HF, chronic atrial fibrillation, right-sided HF, advanced chronic kidney disease, higher New York Heart Association (NYHA) class, lower systolic blood pressure, elevated NT-proBNP, hs-cTnI, urea and creatinine, higher E/E′ ratio and PASP and moderate-to-severe valvular or multivalvular disease. Patients discharged on sodium–glucose cotransporter-2 inhibitors (SGLT2i) or ACE inhibitors/angiotensin receptor blockers (ACEi/ARBs) had lower mortality. In multivariable analysis, NT-proBNP (per 1 standard deviation) remained an independent predictor of mortality (HR 1.398, 95% CI 1.050–1.860; p=0.022), while SGLT2i prescription at discharge was independently associated with improved survival (HR 0.498, 95% CI 0.262–0.946; p=0.033). No other variables remained significant. Conclusions In patients hospitalized with AHF, NT-proBNP is a robust independent predictor of 180-day post-discharge mortality, whereas SGLT2 inhibitor prescription at discharge confers a significant survival benefit. These findings underline the importance of biomarker-based risk stratification and optimization of guideline-directed medical therapy at discharge.