Prognostic impact of the number and Temporality of heart failure Hospitalisations: Analysis of a National healthcare database

• Prior HF hospitalisation is the strongest predictor of adverse outcomes in reduced LVEF. • Both recency and number of hospitalisations have an additive negative impact on mortality and rehospitalisation. • Recent and/or frequent hospitalisations are simple, pragmatic markers to identify high-risk patients. • These patients require prioritisation for guideline-directed therapy, transitional care, and monitoring strategies. To assess the prognostic impact of both the frequency and timing of prior heart failure (HF) hospitalisations on outcomes in patients with reduced left ventricular ejection fraction (LVEF). This nationwide retrospective cohort study used the French national health insurance database to identify 730,052 adults with HF in 2017. A validated algorithm classified 226,747 as HF with reduced LVEF (<45 %), of whom 54,504 (24 %) had at least one HF-related hospitalisation >24 h within the preceding 24 months ( worsening HF group ). Patients were stratified by (1) time since the last HF hospitalisation (0–6, 6–24 months) and (2) number of hospitalisations (1, 2, ≥3). Mean age was 76 ± 15 years. Prior HF hospitalisation was the strongest predictor of mortality among all variables. After multivariable adjustment, prior hospitalisation was associated with increased risk of all-cause death (HR 1.61, 95 % CI 1.56–1.65), all-cause hospitalisation (HR 1.34, 95 % CI 1.32–1.37), and recurrent HF hospitalisation (HR 2.51, 95 % CI 2.43–2.59). Risks were greatest when the most recent hospitalisation occurred within 6 months and rose progressively with the number of prior events. In patients with reduced LVEF, both recent and recurrent HF hospitalisations are strong predictors of mortality and rehospitalisation. These two simple markers identify highly vulnerable patients and should trigger intensified follow-up, optimisation of guideline-directed therapies, and implementation of transitional care and remote monitoring programs.