Diuretic resistance during emergency treatment of acute heart failure: incidence and correlation with 30-day readmission

Objectives: To investigate the incidence of diuretic resistance (DR) during emergency treatment of acute heart failure (AHF) and its correlation with 30-day readmission.Methods: We retrospectively collected data from 198 AHF patients admitted to Beijing Chao-Yang Hospital, Capital Medical University between 2021 and 2025.Patients were allocated into a DR group and non-DR group according to the presence of diuretic resistance.Baseline characteristics, laboratory values, echocardiographic indices, and readmission rate were compared between the two groups.Logistic regression was performed to analyze the correlation between DR and short-term readmission rate.A nomogram was constructed to develop a clinical prediction model for readmission, and SHapley Additive exPlanations (SHAP) were used for model interpretation.Results: DR occurred in 48 patients (24.24%).The 30-day readmission rate was higher in the DR group than in the non-DR group (37.5% vs. 18.0%,P<0.05).Multivariate logistic regression analysis identified DR (OR=4.69,95% CI: 2.17-10.16,P<0.001),New York Heart Association (NYHA) functional class (OR=5.05,95% CI: 2.26-11.26,P<0.001), and left ventricular ejection fraction (LVEF) (OR=0.90,95% CI: 0.86-0.94,P<0.001) as independent risk factors for readmission.The combined model demonstrated a significantly higher area under the receiver operating characteristic curve (ROC-AUC) compared to individual predictors (P<0.05).Conclusions: The incidence of DR in AHF patients during emergency treatment is closely associated with an increased risk of 30-day readmission.Early identification and intervention for DR may improve short-term prognosis.