Longitudinal Changes in Hematological Status and Functional Capacity During Hospitalization Are Associated With Clinical Outcomes in Older Patients With Acute Decompensated Heart Failure

Background: Hemoglobin (Hb) and red cell distribution width (RDW), are routinely measured hematological parameters that reflect anemia, inflammation, and nutritional status. The 6-min walk distance (6MWD) test is a well-established indicator of functional capacity. However, all these parameters are predominantly evaluated at a single time point, and the prognostic implications of their longitudinal changes during hospitalization in acute decompensated heart failure (ADHF) remain unclear. Therefore, in this study we investigated the association between longitudinal changes in the Hb-to-RDW ratio (∆Hb/RDW) during hospitalization and clinical outcomes in patients with ADHF. Methods and Results: The data for 670 consecutive patients hospitalized with ADHF were analyzed. Hb/RDW and 6MWD were assessed at baseline and discharge, and ∆Hb/RDW was calculated. Kaplan–Meier and Cox regression analyses were used to examine the association between ∆Hb/RDW and all-cause death after discharge. During a median follow-up of 2.0 (1.0–3.3) years, 214 patients (31.9%) died. Kaplan–Meier analysis showed a significantly lower all-cause mortality rate in patients with increased ∆Hb/RDW compared with those without an increase. Exploratory analyses suggested graded differences in mortality risk when ∆Hb/RDW was considered together with changes in the 6MWD during hospitalization. Conclusions: An increase in ∆Hb/RDW during hospitalization was associated with a lower risk of all-cause death in older patients with ADHF.