Clinical characteristics and serum HDL-C are associated with adverse prognosis in patients with acute decompensated heart failure with preserved ejection fraction at admission

Purpose This study aimed to investigate whether clinical characteristics and lipid metabolism parameters are associated with adverse prognosis in patients hospitalized for acute decompensated heart failure (HF) with preserved or reduced left ventricular ejection fraction (LVEF). Methods This study included 158 patients with chronic heart failure who were hospitalized at the Shaanxi Provincial People’s Hospital, Shaanxi, China, between January 2021 and October 2024. They were categorized based on their ejection fraction (EF) into a heart failure preserved EF group [heart failure with preserved ejection fraction (HFpEF); n = 73] and a heart failure reduced EF group [heart failure with reduced ejection fraction (HFrEF); n = 85]. The association of their clinical characteristics and lipid energy metabolism parameters with disease prognosis was assessed using univariate and multivariate logistic regression models. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of adverse cardiovascular events. Receiver operating characteristic (ROC) curve analysis was performed to assess the independent prediction performance of the potential risk or protective factors. Results The HFpEF and HFrEF groups showed significant differences in clinical symptoms, including palpitations/angina, cough, sleep at night, lack of appetite, weight loss, abdominal distension, worrying, irritability, decreased libido, and hypertension ( p < 0.05). Furthermore, the groups showed significant differences in peak systolic BP, peak diastolic BP, total cholesterol, and high-density lipoprotein cholesterol (HDL-C) ( p < 0.05). The multivariate logistic regression analysis results showed that a high level of HDL-C has certain discriminatory ability in the prognosis assessment of patients with heart failure (OR = 0.265, 95% CI: 0.085–0.781; p = 0.038), and the AUC value is 0.611 (95% CI: 0.519–0.703, p = 0.021). Conclusions In patients admitted with acute decompensated HF, clinical indicators of congestion, psychological distress, blood pressure load, total cholesterol, and HDL-C are associated with adverse prognosis. Higher HDL-C shows modest but independent prognostic value in acute HF, especially in HFpEF. Further studies are warranted to explore dynamic changes in HDL-C and its role as a metabolic biomarker in HFpEF.