Key result
Early post-discharge HF instability is linked to ~3.4-fold higher subsequent all-cause mortality.
Why the study?
The temporal impact of early post-discharge instability and the cumulative burden of post-discharge HF events on subsequent mortality after hospitalization for AHF remained incompletely characterized.
Does early post-discharge instability and recurrent heart failure event burden increase subsequent all-cause mortality in patients discharged alive after hospitalization for acute heart failure?
Cohort (n=2,142)
Does early post-discharge instability and recurrent heart failure event burden increase subsequent all-cause mortality in patients discharged alive after hospitalization for acute heart failure?
Early post-discharge HF events within 30 days and an accumulating burden of recurrent HF events within 90 days are strongly and stepwisely associated with increased subsequent all-cause mortality after acute heart failure hospitalization.
Answers are grounded in this paper and cite their sources.
Supports risk stratification after HF hospitalization; leaves open whether early interventions reduce mortality.
Background The early post-discharge period after hospitalization for acute heart failure (AHF) represents a phase of heightened clinical vulnerability. Although recurrent hospitalizations are recognized markers of poor prognosis, the temporal impact of early instability and the cumulative burden of post-discharge HF events on subsequent mortality remain incompletely characterized. Objective To evaluate the impact of early post-discharge instability and recurrent HF event burden on subsequent all-cause mortality using landmark analyses. Methods We conducted a retrospective observational cohort study including consecutive patients discharged alive after hospitalization for AHF (January 2019–October 2025). HF events were defined as HF rehospitalization or emergency department visits for HF. Two landmark analyses were performed:Early instability (0–30 days): patients alive at day 30 were classified according to ≥1 HF event within 30 days. Mortality was assessed after day 30.Recurrent burden (0–90 days): patients alive at day 90 were categorized as 0, 1, 2, or ≥3 HF events within 90 days. Mortality was assessed after day 90. Time-to-event analyses were performed using Cox proportional hazards models adjusted for age, sex, admission systolic blood pressure, and heart rate. Results A total of 2,142 patients were discharged alive. Median follow-up for mortality was 350 days (IQR 60–866). Among patients alive at day 30, early instability (≥1 HF event within 30 days) was associated with higher subsequent mortality (adjusted HR 3.37, 95% CI 2.38–4.78; p<0.001). At day 90, 1,510 patients remained alive and constituted the 90-day landmark cohort. Increasing HF event burden within 90 days was associated with stepwise increases in mortality after day 90:1 event: HR 1.61 (95% CI 1.04–2.50; p=0.032)2 events: HR 4.46 (95% CI 2.34–8.53; p<0.001)≥3 events: HR 6.30 (95% CI 1.98–20.09; p=0.002) Conclusions Early post-discharge instability and accumulating HF event burden identify a progressively higher-risk population beyond the index hospitalization. These findings support the concept of a dynamic post-discharge vulnerability phase, in which recurrent HF events mark transition to sustained high mortality risk.Early HF Instability and Mortality90-Day HF Burden and Survival
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Burgos et al. (2026) conducted a cohort in Acute heart failure (n=2,142). Early post-discharge instability (≥1 HF event within 30 days) and 90-day recurrent HF event burden vs. No post-discharge HF events was evaluated on Subsequent all-cause mortality (HR 3.37, 95% CI 2.38-4.78, p=<0.001). Early post-discharge instability (≥1 HF event within 30 days) was associated with higher subsequent all-cause mortality (adjusted HR 3.37; 95% CI 2.38-4.78; p<0.001).
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