Background: Worsening heart failure (WFH) includes heart failure (HF) hospitalisation, representing a strong predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, there is little evidence analysing the impact of the number of previous HF admissions. Our main objective was to analyse the clinical profile according to the number of previous admissions for HF and its prognostic impact in the medium and long term. Methods: A retrospective study of a cohort of patients with HFrEF, classified according to previous admissions: cohort-1 (0–1 previous admission) and cohort-2 (≥2 previous admissions). Clinical, echocardiographic and therapeutic variables were analysed, and the medium- and long-term impacts in terms of hospital readmissions and cardiovascular mortality were assessed. A total of 406 patients were analysed. Results: The mean age was 67.3 ± 12.6 years, with male predominance (73.9%). Some 88.9% (361 patients) were included in cohort-1, and 45 patients (11.1%) were included in cohort-2. Cohort-2 had a higher proportion of atrial fibrillation (49.9% vs. 73.3%; p = 0.003), chronic kidney disease (36.3% vs. 82.2%; p < 0.001), and anaemia (28.8% vs. 53.3%; p = 0.001). Despite having similar baseline ventricular structural parameters, cohort-1 showed better reverse remodelling. With a median follow-up of 60 months, cohort-1 had longer survival free of hospital readmissions for HF (37.5% vs. 92%; p < 0.001) and cardiovascular mortality (26.2% vs. 71.9%; p < 0.001), with differences from the first month. Conclusions: Patients with HFrEF and ≥2 previous admissions for HF have a higher proportion of comorbidities. These patients are associated with worse reverse remodelling and worse medium- and long-term prognoses from the early stages, wherein early identification is essential for close follow-up and optimal intensive treatment.

Introduction: The increasingly active role of nurses in the management of heart failure (HF) has become important in HF units (HCUs). This study aims to determine the effect of opening a specialised HF nursing (NSHF) consultation in a tertiary hospital on drug titration, and its subsequent impact on cardiac remodelling and prognosis. Methods: A retrospective cohort study was conducted on patients with HF with reduced ejection fraction (HFrEF) who were treated between 2017 and 2020. Patients who were followed by the NSHF were compared with those who underwent conventional clinical follow-up (non-NSHF), focusing on drug optimisation, echocardiographic parameters, biomarkers, and clinical outcomes in terms of mortality and hospital readmissions for HF. Results: A total of 411 patients were analysed, 85 of whom (20.7%) were treated with NSHF. There were hardly any differences in baseline characteristics. At the end of follow-up, the NSHF group had a higher prescription rate of angiotensin receptor–neprilysin inhibitor (+31.7% vs. +23.3%; p < 0.001), beta-blockers (+2.4% vs. −5.8%; p < 0.001), and sodium glucose co-transporter type 2 inhibitors (+24.7% vs. +17.8%; p < 0.001). There was also a higher rate of loop diuretic withdrawal (−16.7% vs. −6.7%; p < 0.001). However, no improvement in reverse remodelling or neurohormonal response was observed. Patients treated with NSHF had a lower probability of dying from HF (88.6% vs. 63.3%; p = 0.006), but this did not reduce hospital admissions for HF. Conclusions: Patients with HFrEF who are cared for through NSHF are more likely to be prescribed drugs that modify the prognosis of the disease. This has an impact on their mortality.

Background: The coexistence of heart failure with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) is a common health problem that complicates therapeutic management and worsens prognosis. Our aim was to analyse the association between COPD and HF treatment optimization, long-term clinical outcomes, mortality, and HF readmissions. Methods: A retrospective, observational study comparing two cohorts: HFrEF with COPD versus HFrEF without COPD. Beta-blocker (BB) and ivabradine dose optimization were assessed in both groups, and inhaled treatment was assessed in patients with COPD. Clinical outcomes during follow-up were analyzed using Kaplan–Meier methods and Cox proportional hazards regression. Results: 375 patients were included, of whom 71 had COPD (18.9%). No significant differences were observed between groups in BB or ivabradine dose optimization. After 60 months of follow-up, patients with COPD had higher rates of all-cause mortality (40.8% vs. 25.6%; p = 0.014), HF-related mortality (33.8% vs. 18.4%; p = 0.006), and HF readmission (50.7% vs. 35.2%; p = 0.014). COPD remained significantly associated with adverse clinical outcomes in multivariable Cox regression analysis. Among patients with COPD, dual inhaled therapy was the most common regimen (54.9%), followed by triple inhaled therapy (32.4%). Conclusions: In our cohort of patients with HFrEF, concomitant COPD was associated with higher mortality and HF readmission rates despite similar BB and ivabradine dose optimization between groups. These findings highlight the importance of COPD in the clinical management of patients with HFrEF, although the observational design of the study precludes causal conclusions. Further studies are warranted to clarify the relationship between COPD, HF outcomes, and treatment patterns.