What does this research mean for the field?

The AD2NNER risk score effectively predicts HF rehospitalizations in patients, with scores ≥4 associated with significantly lower event-free survival (log-rank p=0.005). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To identify factors contributing to adverse outcomes in heart failure patients and develop a risk prediction score.

February 6, 2026

Prediction model of rehospitalization in heart failure with preserved and mildly-reduced ejection fraction: the AD2NER risk score

Key Result

The AD2NNER risk score, based on six clinical variables, effectively predicts HF rehospitalization with a cutoff ≥4 indicating significantly lower event-free survival (p=0.005).

Key Points

To identify factors contributing to adverse outcomes in heart failure patients and develop a risk prediction score.
Enrolled 1,022 HFpEF and HFmrEF inpatients discharged from January 2019 to May 2023.
Collected demographic, clinical, biological, and imaging data for analysis.
Employed univariable analysis to identify parameters associated with rehospitalization.
Used multivariable Cox regression to determine independent predictors for rehospitalization.
30.1% of patients experienced rehospitalization after an average follow-up of 3.5 years.
Identified six independent predictors for rehospitalization including age and type 2 diabetes.
Developed the AD2NNER risk score based on these predictors, with a cutoff of 4 for significant risk stratification.
Lower event-free survival noted in patients scoring ≥4 on the risk score.

Structured PICO

Does the AD2NER risk score effectively predict heart failure rehospitalization in patients with HFpEF and HFmrEF?

Population

1,022 inpatients with heart failure with preserved (HFpEF) and mildly-reduced (HFmrEF) ejection fraction discharged between January 2019 and May 2023.

Intervention

AD2NER risk score (a 6-variable model including age, type 2 diabetes mellitus, NYHA class, HF etiology, cardiac rhythm, and serum sodium)

Outcome

Heart failure rehospitalizationhard clinical

The AD2NER risk score is a simple, 6-variable model that effectively stratifies the risk of heart failure rehospitalization in patients with HFpEF and HFmrEF.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Aims This study aimed to identify factors linked to adverse outcomes in patients with heart failure with preserved (HFpEF) and mildly-reduced (HFmrEF) ejection fraction and to develop a multivariable risk prediction score. Methods We enrolled 1,022 HFpEF and HFmrEF inpatients discharged between January 2019 and May 2023. Demographic, clinical, biological, and imaging data were collected for analysis. Results After a mean follow-up of 3.5 ± 1.4 years, 308 (30.1%) patients experienced HF rehospitalization, and 346 (33.9%) reached the secondary composite endpoint of HF rehospitalization or all-cause death. Univariable analysis identified several parameters associated with HF rehospitalization, including age (p0.001), male gender (p=0.015), type 2 diabetes mellitus (T2DM, p=0.016), arterial hypertension (p=0.018), smoking (p=0.029), NYHA class at discharge (p=0.006), cardiac rhythm (p=0.003), HF etiology (p=0.011), serum sodium (p=0.002), and several echocardiographic measures. Multivariable Cox regression revealed six independent predictors: age (p0.001), T2DM (p=0.026), NYHA class (p=0.010), HF etiology (p=0.037), cardiac rhythm (p=0.001), and serum sodium (p=0.005). These variables formed the AD2NNER risk score, ranging from 0 to 9 points. At Kaplan-Meier analysis, patients scoring ≥4 had significantly lower event-free survival (log-rank p=0.005). Conclusion The AD2NNER risk score is a simple, six-variable model that effectively predicts HF rehospitalizations, with a cutoff of 4 providing robust risk stratification for HFpEF and HFmrEF inpatients.Flowchart Kaplan Meier analysis

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