Early clues to long-term outcomes: predicting 180-day mortality in acute heart failure

Abstract Background Acute heart failure (AHF) is associated with substantial post-discharge mortality despite advances in therapy. Early identification of high-risk patients is essential to guide follow-up and treatment optimization. Purpose To determine early clinical, laboratory, echocardiographic and treatment-related predictors of 180-day mortality among patients hospitalized with AHF. Materials-Methods This prospective single-center study included consecutive patients admitted with AHF between February 2023 and January 2025. Demographics, comorbidities, admission laboratory parameters (NT-proBNP, creatinine, urea, estimated glomerular filtration rate eGFR, high-sensitivity troponin-I hs-cTnI), hemodynamic parameters, echocardiographic indices (left ventricular ejection fraction LVEF, E/E′ ratio, tricuspid annular systolic velocity S′, pulmonary artery systolic pressure PASP, valvular disease), and discharge heart failure (HF) medication were collected. Patients with in-hospital death, incomplete data, or chronic renal replacement therapy were excluded. The primary endpoint was 180-day post-discharge mortality. Results Among 413 patients, 59 (14.3%) died within 180 days. In univariate analyses, predictors of mortality included older age, chronic HF, chronic atrial fibrillation, right-sided HF, advanced chronic kidney disease, higher New York Heart Association (NYHA) class, lower systolic blood pressure, elevated NT-proBNP, hs-cTnI, urea and creatinine, higher E/E′ ratio and PASP and moderate-to-severe valvular or multivalvular disease. Patients discharged on sodium–glucose cotransporter-2 inhibitors (SGLT2i) or ACE inhibitors/angiotensin receptor blockers (ACEi/ARBs) had lower mortality. In multivariable analysis, NT-proBNP (per 1 standard deviation) remained an independent predictor of mortality (HR 1.398, 95% CI 1.050–1.860; p=0.022), while SGLT2i prescription at discharge was independently associated with improved survival (HR 0.498, 95% CI 0.262–0.946; p=0.033). No other variables remained significant. Conclusions In patients hospitalized with AHF, NT-proBNP is a robust independent predictor of 180-day post-discharge mortality, whereas SGLT2 inhibitor prescription at discharge confers a significant survival benefit. These findings underline the importance of biomarker-based risk stratification and optimization of guideline-directed medical therapy at discharge.Demographics and comorbiditiesFor image description, please refer to the figure legend and surrounding text. Biochemical and other markersFor image description, please refer to the figure legend and surrounding text.