REACT-HF study: REhospitalizations in elderly patients with Advanced Cardiac Telemonitoring

Abstract Background Older adults hospitalized for acute decompensated heart failure (HF) are at particularly high risk of early readmission and loss of autonomy after discharge. Although ESC guidelines recommend early follow-up and digital monitoring, real-world data in very elderly and frail populations remain limited. The REACT-HF study assessed 12-month outcomes of a cardiogeriatric post-acute pathway integrating nurse-assisted telemonitoring, digital alerts, and multidisciplinary coordination. Methods This real-world observational, retrospective study included consecutive patients aged ≥ 65 years hospitalized for acute decompensated HF in a cardiogeriatric unit and subsequently enrolled at discharge in a structured telemonitoring program, with ≥ 12-month follow-up. The primary endpoint was ≥ 1 unplanned HF rehospitalization within 12 months. Secondary endpoints included the number and duration of HF rehospitalizations and potential clinical, biological, and geriatric predictors. Group comparisons used Mann–Whitney U and χ²/Fisher tests; independent predictors were identified by multivariable logistic regression. Results A total of 255 patients were analyzed (median age 87 81–91 years; 54 % female; ADL 5.5 5–6; BMI 25.3 22.4–29.1 kg/m²; albumin 32 28.5–35.5 g/L; Charlson 8 6–9). At 12 months, 63 patients (24.7 %) experienced ≥ 1 HF rehospitalization. Median length of stay for these events was 8 6–12 days. In univariate analyses, rehospitalized patients had higher NT-proBNP at discharge (p = 0.033), lower ferritin (p 0.001), and higher loop-diuretic dose (p 0.001). In multivariable analysis, three independent predictors of 12-month HF rehospitalization were identified: chronic obstructive pulmonary disease (COPD, p = 0.043), ≥ moderate mitral regurgitation (p = 0.008), and absolute iron deficiency (p = 0.001). NT-proBNP , ferritin (continuous), and diuretic dose lost significance after adjustment. Conclusions In this very elderly HF cohort discharged after acute decompensation, the 12-month HF rehospitalization rate was 24.7 %, lower than expected for this high-risk population. A nurse-assisted, algorithm-based telemonitoring model implemented at the transition from hospital to home proved feasible, safe, and aligned with ESC recommendations for post-acute HF care. Independent predictors (COPD, mitral regurgitation, iron deficiency) highlight actionable comorbid targets for cardio-pulmonary-renal and iron-replacement strategies. REACT-HF demonstrates the feasibility and transferability of a cardiogeriatric post-acute pathway designed to reduce avoidable readmissions and strengthen continuity of HF care.