Background: The venous excess ultrasound score (VExUS) is used to objectify systemic venous congestion. The aim of the paper was to determine the association between VExUS grades and worsening renal function (WRF), reduced natriuretic response, diuretics resistance, and mortality in patients with acute heart failure (AHF). Methods: One hundred patients were included, and Doppler ultrasound of hepatic, portal, and renal veins was performed. Severity of congestion was graded using the VExUS score (grade 0, 1, 2, or 3). Sodium concentration in a spot urine sample was assessed in 2 h after the first loop diuretic administration and was adjusted for the prescribed dose of furosemide (31 mmol/40 mg). Diuretics resistance was defined as the need to double the starting dose of intravenous furosemide in 6 h. Results: Patients with VExUS grade 3 showed a higher incidence of WRF (OR: 11.17; 95% CI: 3.86–32.29; p < 0.001) and a decreased natriuretic response: a spot urine sodium content of <50 mmol/L (OR: 21.53; 95% CI: 5.32–87.06; p < 0.001) and an adjusted spot urine sodium content of <31 mmol/40 mg (OR: 9.05; 95% CI: 3.15–25.96; p < 0.001). The risk of diuretic resistance (OR: 15.31; 95% CI: 5.05–46.43; p < 0.001), as well as the need for inotropic and/or vasopressor support (OR: 11.82; 95% CI: 3.59–38.92; p < 0.001), was higher in patients with severe congestion. The hospital mortality rate increased in patients with VExUS grade 3 compared to in patients with other grades (OR: 26.4; 95% CI: 5.29–131.55; p < 0.001). Conclusions: Patients with AHF and VExUS grade 3 showed a higher risk of developing WRF, a decreased diuretic and natriuretic response, a need for inotropic and/or vasopressor support, and a poor prognosis during their hospital stay.

Background: Acute heart failure (AHF) is one of the leading causes of admissions to the emergency department (ED). There is a need to develop an easy-to-use score that can be used in the ED to risk-stratify patients with AHF and in hospitalization decisions regarding cardiac wards or intensive care units (ICUs). Methods: A retrospective observational study was conducted at a city hospital. The data from the presentation of AHF patients at the ED were collected. The combined primary endpoint included death from any cause during hospitalization or transfer to an intensive care unit (ICU) for using inotropes/vasopressors. Feature selection was performed using artificial intelligence. Results: From August 2020 to August 2021, 908 patients were enrolled (mean age: 71.6 ± 13 years; 500 (55.1%) men). We found significant predictors of in-hospital mortality and ICU transfers for inotrope/vasopressor use and built two models to assess the need for ICU admission of patients from the ED. The first model included SpO₂ < 90%, QTc duration, prior diabetes mellitus and HF diagnosis, serum chloride concentration, respiratory rate and atrial fibrillation on admission, blood urea nitrogen (BUN) levels, and any implanted devices. The second model included left ventricular end-diastolic size, systolic blood pressure, pulse blood pressure, BUN levels, right atrium size, serum chloride, sodium and uric acid concentrations, prior loop diuretic use, and pulmonary artery systolic blood pressure. Conclusions: We developed two models that demonstrated a high negative predictive value, which allowed us to distinguish patients with low risk and determine patients who can be hospitalized and sent from the ED to the floor. These easy-to-use models can be used at the ED.

Background: Acute heart failure (AHF) is a common cause of hospital admission with high morbidity and mortality. Up to one-third of AHF patients require rehospitalization during the first three months after discharge due to the nature of disease and the patient’s characteristics. In this regard, the first 3 months after an episode of decompensation of heart failure are called the “vulnerable” period. However, there is a gap in knowledge about the significance of this rehospitalization on heart failure course. The aim of the study is to evaluate impact on mortality of AHF rehospitalization during 3 months after hospital discharge on a retrospective registry with 3 year follow-up. Methods: Patients after AHF hospitalization episode between 1 December 2020 and 30 November 2023 were monitored via electronical medical records for 3 year follow-up. All patients who survived after index hospitalization were included. The primary endpoint was all-cause mortality. COX-multiple regression was used to evaluate the impact of rehospitalization during 90 days after index discharge on outcomes. p values less than 0.05 were considered to be significant. Results: A cohort of 204 patients, 56.6% males, with an average age of 72 ± 13 years, were included in the study with medium follow-up of 22 ± 12 months. Within 3 months after discharge, 55 (27%) patients were rehospitalized for AHF, and 11 (5%) patients died. Patients who experienced a recurrent episode of AHF were characterized by a history of previous hospitalizations for AHF before inclusion (39 (71%) vs. 72 (48%); p = 0.005), the use of intravenous inotropic drugs (5 (9%) vs. 2 (1%); p = 0.007), higher initial doses of furosemide during index hospitalization (98 ± 46 vs. 82 ± 37; p = 0.01), and higher doses of furosemide at discharge (54 ± 41; 41 ± 33; p = 0.02). Left ventricular ejection fraction (LVEF), prevalence of atrial fibrillation (AF), diabetes mellitus (DM), and chronic kidney disease (CKD) did not differ between the groups. Over 3 years follow-up, 68 (33.2%) patients died, and cardiovascular mortality was 15.6% (32 patients). In multivariate COX-regression age (HR 1.04 [1.008–1.07]), heart rate (HR) on admission (HR 1.02 [1.004–1.03]), and hospitalization within the first 3 months after discharge were independent predictors of death (HR 2.21 [1.32–3.83]). Conclusions: Readmission for AHF within the first 3 months after discharge is an independent risk factor for all-cause cardiovascular mortality during 3 years follow-up.

Aim. To study the incidence and clinical prognostic significance of changes in heart failure (HF) phenotype based on left ventricular ejection fraction (LVEF) changes over 3 years. Material and methods . This retrospective study included 157 patients hospitalized with acute decompensated heart failure (ADHF). The results of baseline echocardiography and repeat examinations at 3, 6, 12, 24, and 36 months were assessed. Patients were divided into subgroups based on baseline LVEF as follows: HF with reduced LVEF (HFrEF) (10% was noted in 31% of patients. In the HFmrEF subgroup, LVEF normalized in 48% of patients, and decreased to <40% in 22%. In the HFpEF subgroup, a decrease in LVEF <40% was recorded in 10% of cases. According to the Cox model, the transition from the HFrEF subgroup to the HF with improved EF subgroup was associated with higher overall survival (HR (hazard ratio) 4,57; 95% confidence interval (CI): 1,039-20,177; p=0,04). The risk of cardiovascular death in patients who transitioned from the HFrEF subgroup to any other subgroup (HFmrEF, HFpEF) was also associated with improved survival (HR 8,852; 95% CI: 1,139-68,805, p=0,04). In the HFpEF subgroup, a decrease in LVEF <40% was associated with an increased risk of cardiovascular mortality (HR 4,906; 95% CI: 1,08622,153; p=0,039). Conclusion. Clinically significant improvement in cardiac function is observed in almost half of patients with a baseline reduced LVEF and is associated with a better prognosis. A decrease in LVEF in the HFpEF subgroup is a predictor of unfavorable outcome.

Objective. To determine the annual prognosis and risk factors for re-hospitalization and death after inpatient treatment of acute decompensated chronic heart failure. Material and methods. A telephone survey of discharged patients was conducted one year after hospitalization for acute decompensated chronic heart failure. Combined primary endpoint included death or hospitalization for any cause within a year after discharge. Secondary endpoints were death and readmissions within a year. Risk factors for poor prognosis were determined using univariate and multivariate regression analysis. Differences were significant at p-value <0.05. Results. The annual mortality rate was 41.9% (n=72), incidence of readmissions for any reason — 58.8% (n=101). Combined primary endpoint occurred in 124 (72.1%) patients. According to univariate regression analysis, anemia (OR 1.74, 95% CI 1.09—2.76; p<0.05) upon admission and episode of diuretic resistance (OR 2.37, 95% CI 1.45—3.87; p<0.01). Angiotensin converting enzyme inhibitors/angiotensin II receptor blockers and dapagliflozin were associated with lower 1-year mortality (OR 0.57, 95% CI 0.35 to 0.93; p< 0.05 and OR 0.61, 95% CI 0. 38—0.98; p<0.05, respectively). Anemia (OR 1.92, 95% CI 1.3—2.8; p<0.01), moderate doses of furosemide upon admission (OR 1.01, 95% CI 1.00—1.02; p< 0.05), diuretic resistance (OR 2.44, 95% CI 1.61—3.69; p<0.01) and comorbidity index (OR 1.1, 95% CI 1.01—1.21; p< 0.05) were associated with 1-year readmissions. The incidence of combined primary endpoint was influenced by anemia upon admission (OR 1.56, 95% CI 1.09—2.22; p<0.05) and diuretic resistance (OR 2.05, 95% CI 1.39—3.02; p<0.01). Multivariate regression analysis of all variables significant in univariate analysis revealed only diuretic resistance as a significant predictor of outcomes (death within a year, readmissions and combined primary endpoint) (OR 2.37, 95% 1.45—3. 87; OR 2.44, 95% CI 1.61—3.69, OR 2.13, 95% CI 1.41—3.20, respectively, p<0.01). Conclusion. Resistance to diuretics following treatment of acute decompensated chronic heart failure is an independent predictor of poor prognosis within a year after discharge.

Aim. To evaluate clinical, demographic, laboratory and instrumental characteristics, treatment, and outcomes of patients with acute decompensated heart failure depending on left ventricular ejection fraction. Material and methods. A consecutive retrospective study was conducted including patients aged 18 years hospitalized with acute decompensated heart failure to a multidisciplinary hospital between December 1, 2019 and December 1, 2021. All patients were divided into 3 groups according to left ventricular ejection fraction, followed by an analysis of patient characteristics. Results. A total of 486 patients were included (55 % men); mean age was 72 ± 12 years. The number of patients with heart failure with reduced ejection fraction was 235 (48 %), with mildly reduced ejection fraction – 117 (24 %), and with preserved ejection fraction – 134 (28 %). More than 60 % of patients required admission to the intensive care unit. The groups differed in sex, age, presence of coronary artery disease, postinfarction cardiosclerosis, history of myocardial revascularization, presence of infection at admission, as well as in physical examination findings, laboratory and instrumental parameters; however, no differences in mortality were observed between the groups (p 0.05). Conclusion. Despite the fact that patients with heart failure with reduced ejection fraction had more severe condition at admission per clinical, laboratory, and instrumental parameters, more often had a history of coronary artery disease, postinfarction cardiosclerosis, and myocardial revascularization, more frequently required inotropic / vasopressor support, and had longer hospital stays, mortality rates were comparable between the groups.