Prediction of the post-hospital complications in patients with decompensated chronic heart failure

Aim . To evaluate the value of the left ventricular global function index (LVGFI) for predicting readmissions and death within 1 year after inpatient treatment for acute decompensated heart failure (ADHF). Material and methods . The study included 100 patients (51% men) aged 73.8±7.5 years hospitalised for ADHF. Follow-up lasted 12 months; the primary composite endpoint was readmission for ADHF and/or posthospital death. All patients underwent a medical history and physical examination, laboratory tests, a six-minute walk test after stabilization, and transthoracic echocardiography with subsequent calculation of the LVGFI. Results . During the follow-up period, 40 patients achieved the primary endpoint (35 patients had readmissions for ADHF alone, and 5 patients had readmissions and death due to ADHF). Based on the outcome, patients were divided into 2 groups: those with readmissions and/or death and those without adverse events. Significant differences were found between the groups in LVGFI (p<0.001), 6-minute walk distance (p=0.012), the presence of type 2 diabetes mellitus (DM) (p=0.017), and chronic kidney disease (CKD) stages 4-5 (p=0.022). The cutoff value of LVGFI for predicting readmissions and/or death according to ROC analysis was 12.6% with a sensitivity of 71.7% and a specificity of 75% (AUC 0.768 (95% CI 0.671-0.865, p<0.001)). In the Cox proportional hazards model, LVGFI <12.6% was an independent predictor of the composite endpoint, increasing the risk of adverse outcomes by 3.8 times compared to patients with LVGFI ≥12.6%. Type 2 diabetes mellitus, CKD stages 4–5, and six-minute walk test distance did not reach statistical significance in the multivariate analysis. Conclusion . An LVGFI value of <12.6% can be considered a significant predictor of adverse outcomes (rehospitalisation and/or death) during the first year of post hospitalisation in patients who have experienced an episode of ADHF. Using LVGFI may facilitate more accurate posthospital risk stratification and identify the most vulnerable group of patients requiring more intensive monitoring and optimisation of therapy after discharge.