Introduction: Heart failure is an extremely prevalent disease in the elderly population of the world. Most patients present signs and symptoms of decompensation of the disease due to worsening congestion. This congestion has been clinically assessed through clinical signs and symptoms and complementary imaging tests, such as chest radiography. Recently, pulmonary and inferior vena cava ultrasound has been shown to be useful in assessing congestion but its prognostic significance in elderly patients has been less well evaluated. Objectives: This study aims to compare the clinical and radiological characteristics and predictive values for mortality in patients admitted for heart failure through the determination of B lines by lung ultrasound and the degree of collapsibility of the inferior vena cava (IVC). Secondarily, the study aims to assess the prediction of 30-day mortality based on the diameter of the IVC by means of the ROC curve. Methods: This is an observational cohort study based on data collected in the PROFUND-IC study, a nationwide multicentric registry of patients admitted with decompensated heart failure. Data were collected from these patients between October 2020 and April 2022. Results: A total of 482 patients were entered into the PROFUND-IC registry between October 2020 and April 2022. Bedside clinical ultrasound was performed during admission in 301 patients (64.3%). The number of patients with more than 6 B-lines on lung ultrasound amounted to 194 (66%). Statistically significant differences in 30-day mortality (22.1% vs. 9.2%; p = 0.01) were found in these patients. The sum of patients with IVC collapsibility of less than 50% amounted to 195 (67%). Regarding prognostic value, collapsibility data were significant for the number of admissions in the last year (12.5% vs. 5.5%; p = 0.04), in-hospital mortality (10.1% vs. 3.3%, p = 0.04) and 30-day mortality (22.6% vs. 8.1%; p < 0.01), but not for readmissions. Regarding the prognostic value of IVC diameter for 30-day mortality, the area under the ROC curve (AUC) was 0.73, with a p < 0.01. The curve cut-off point with the highest sensitivity (70%) and specificity (70.3%) was for an IVC value of 22.5 mm. In the logistic regression analysis, we observed that the variable most associated with patient survival at 30 days was the presence of a collapsible inferior vena cava, with more than 50% OR 0.359 (CI 0.139–0.926; p = 0.034). Conclusions: The subgroups of patients analyzed with more than six B lines per field and IVC collapsibility less than or equal to 50%, as measured by clinical ultrasound, had higher 30-day mortality rates than patients who did not fall into these subgroups. IVC diameter may be a good independent predictor of 30-day mortality in patients with decompensated heart failure. Comparing both ultrasound variables, it seems that in our population, the assessment of the inferior vena cava may be more associated with short-term prognosis than the pulmonary congestion variables assessed by B lines.

Background: Most patients diagnosed with heart failure (HF) are older adults with multiple comorbidities. Multipathological patients constitute a population with common characteristics: greater clinical complexity and vulnerability, frailty, mortality, functional deterioration, polypharmacy, and poorer health-related quality of life with more dependency. Objectives: To evaluate the clinical characteristics of hospitalized patients with acute heart failure and to determine the prognosis of patients with acute heart failure according to the Short Physical Performance Battery (SPPB) scale. Methods: Observational, prospective, and multicenter cohort study conducted from September 2020 to May 2022 in patients with acute heart failure as the main diagnosis and NT-ProBNP > 300 pg. The cohort included patients admitted to internal medicine departments in 18 hospitals in Spain. Epidemiological variables, comorbidities, cardiovascular risk factors, cardiovascular history, analytical parameters, and treatment during admission and discharge of the patients were collected. Level of frailty was assessed by the SPPB scale, and dependence, through the Barthel index. A descriptive analysis of all the variables was carried out, expressed as frequencies and percentages. A bivariate analysis of the SPPB was performed based on the score obtained (SPPB ≤ 5 and SPPB > 5). For the overall analysis of mortality, HF mortality, and readmission of patients at 30 days, 6 months, and 1 year, Kaplan–Meier survival curves were used, in which the survival experience among patients with an SPPB > 5 and SPPB ≤ 5 was compared. Results: A total of 482 patients were divided into two groups according to the SPPB with a cut-off point of an SPPB < 5. In the sample, 349 patients (77.7%) had an SPPB ≤ 5 and 100 patients (22.30%) had an SPPB > 5. Females (61%) predominated in the group with an SPPB ≤ 5 and males (61%) in those with an SPPB > 5. The mean age was higher in patients with an SPPB ≤ 5 (85.63 years). Anemia was more frequent in patients with an SPPB ≤ 5 (39.5%) than in patients with an SPPB ≥ 5 (29%). This was also seen with osteoarthritis (32.7%, p = 0.000), diabetes (49.6%, p = 0.001), and dyslipidemia (69.6%, p = 0.011). Patients with an SPPB score > 5 had a Barthel index < 60 in only 4% (n = 4) of cases; the remainder of the patients (96%, n = 96) had a Barthel index > 60. Patients with an SPPB > 5 showed a higher probability of survival at 30 days (p = 0.029), 6 months (p = 0.031), and 1 year (p = 0.007) with (OR = 7.07; 95%CI (1.60–29.80); OR: 3.9; 95%CI (1.30–11.60); OR: 6.01; 95%CI (1.90–18.30)), respectively. No statistically significant differences were obtained in the probability of readmission at 30 days, 6 months, and 1 year (p > 0.05). Conclusions: Patients admitted with acute heart failure showed a high frequency of frailty as assessed by the SPPB. Patients with an SPPB ≤ 5 had greater comorbidities and greater functional limitations than patients with an SPPB > 5. Patients with heart failure and a Barthel index > 60 frequently presented an SPPB < 5. In daily clinical practice, priority should be given to performing the SPPB in patients with a Barthel index > 60 to assess frailty. Patients with an SPPB ≤ 5 had a higher risk of mortality at 30 days, 6 months, and 1 year than patients with an SPPB ≤ 5. The SPPB is a valid tool for identifying frailty in acute heart failure patients and predicting 30-day, 6-month, and 1-year mortality.

Background: Older adults hospitalized with acute heart failure frequently present with multimorbidity, frailty, and reduced physiological reserve. This makes accurate prognostic assessment particularly challenging in internal medicine. Traditional heart failure risk models often fail to capture this multidimensional vulnerability. The PROFUND index, developed to estimate medium-term mortality in multimorbid patients, and serum albumin, an established biomarker of nutritional and inflammatory status, may provide complementary prognostic information. This formed the aim of the present study. This study’s objective is to evaluate the individual and combined prognostic value of the PROFUND index and serum albumin for one-year mortality in patients admitted with AHF. Methods: We conducted a prospective, multicenter cohort study within the PROFUNDIC registry. We included consecutive adults hospitalized with AHF or decompensated chronic heart failure who met European Society of Cardiology diagnostic criteria and had NT-proBNP levels > 1500 pg/mL. PROFUND scores were obtained at admission, and hypoalbuminaemia was dichotomized as ≤3.5 g/dL. The primary outcome was one-year mortality, analyzed using Kaplan–Meier survival estimates, Cox proportional hazards models, and time-dependent ROC curves. Results: Among 544 included patients (mean age 85 years; 60% women), high PROFUND scores (>7) were present in 39% and hypoalbuminaemia in 55%. Both variables independently predicted one-year mortality, with the highest risk observed in patients presenting both high PROFUND scores (HR 2.26; 95% CI 1.66–3.09; p < 0.001) and hypoalbuminaemia (HR 1.70; 95% CI 1.18–2.46; p = 0.0046). The combined use of these markers modestly improved discriminatory performance compared with the PROFUND index alone (HR 2.83; 95% CI 1.72–4.64; p < 0.000). Conclusions: These findings suggest that integrating clinical complexity, assessed by the PROFUND index, with serum albumin provides a simple and clinically meaningful approach to early risk stratification in very elderly multimorbid patients treated in internal medicine wards.

Background/Objectives: Heart failure (HF) is a highly prevalent clinical syndrome with serious morbidity and mortality. Furthermore, acute heart failure (AHF) is the main cause of hospital admission in people aged 65 years or more. Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) have been shown to improve the survival and quality of life in patients with HF regardless of left ventricular ejection fraction (LVEF). Our aims were to describe the characteristics of adults with multiple pathologies admitted with acute heart failure as the main diagnosis and of the population treated with SGLT2is, as well as to evaluate if their use was associated with lower readmission and mortality rates. Methods: A prospective study of patients from the PROFUND-IC registry who were admitted with AHF as the main diagnosis was conducted. Clinical and analytical characteristics were analyzed, as well as readmissions and mortality. Descriptive and bivariate analyses of the sample between those taking SGLT2is and those who were not were performed, using the chi-square test for qualitative variables and Welch’s test for quantitative measures, as well as the Fisher and Wilcoxon tests as indicated for nonparametric tests. Kaplan–Meier curves were constructed to analyze the readmission and mortality of patients at 12 months based on SGLT2i treatment. Finally, a propensity score matching was performed, guaranteeing that the observed effect of the drug was not influenced by the differences in the characteristics between the groups. Results: There were 750 patients included: 58% were women, and the mean age was 84 years. Functional class II according to the NYHA scale predominated (54%), and the mean LVEF was 51%. SGLT2 inhibitors were prescribed to only 28% of patients. Most of the patients were men (48.6% vs. 39.8%, p = 0.029), they were younger (82 vs. 84 years, p = 0.002), and their LVEF was lower (48% vs. 52%, p < 0.001). Lower mortality was observed in the group treated with SGLT2is, both during baseline admission (2.4% vs. 6.9%, p = 0.017) and at the 12-month follow-up (6.2% vs. 13%, p = 0.023); as well as a lower readmission rate (23.8% vs. 38.9%, p < 0.001). After the propensity score matching, a decrease in the 12-month readmission rate continued to be observed in the group treated with SGLT2is (p = 0.03). Conclusions: SGLT2is use was associated with lower readmission rates at the 12-month follow-up in older adults with multiple pathologies admitted with acute heart failure.

Background/Objectives: Acute heart failure (AHF) is the leading cause of hospitalization among patients over 65 years and is frequently associated with frailty. Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) currently represent the only drug class recommended across the entire ejection fraction spectrum, although evidence regarding their effectiveness according to frailty status remains limited. Aims: To determine whether functional frailty, measured by the Short Physical Performance Battery (SPPB) test, influences the effectiveness of SGLT2i in reducing hospital readmission and mortality in elderly patients with AHF. Methods: Observational study of 794 polypathological patients admitted to Internal Medicine with AHF. An interaction analysis assessed whether SPPB, as a continuous variable, modified the association between SGLT2i and the composite outcome (hospital readmission or death), using a Cox model. The sample was further divided by SPPB test score (below 4 (N = 477) or ≥4 (N = 317)) for exploratory analyses. Descriptive and comparative analyses were performed according to SGLT2i administration, using the chi-squared test for qualitative variables and Student’s t-test for quantitative ones (Fisher’s and Mann–Whitney U test as appropriate). Survival analysis was done using Kaplan–Meier curves and Cox regression, with multivariable adjustment for confounders. Results: No significant interaction was found between SPPB score and SGLT2i (p = 0.506). When SPPB was dichotomised, SGLT2i treatment was associated with significantly lower all-cause mortality (3.7% vs. 12.0%; p = 0.018) and readmission (30.3% vs. 45.2%; p = 0.021) in SPPB ≥ 4, with mortality and readmission also numerically lower, without reaching statistical significance, in SPPB < 4 (mortality 12.9% vs. 16.9%, p = 0.410; readmission 34.5% vs. 42.0%, p = 0.220). After adjustment, SGLT2i treatment in the SPPB ≥ 4 group remained associated with a numerically lower hazard for the composite outcome (HR 0.652; 95% CI 0.418–1.018; p = 0.060). Conclusions: No evidence was found that functional frailty modifies the effectiveness of SGLT2i in elderly polypathological patients with AHF. An exploratory analysis suggested a possible gradient of greater association with SPPB ≥ 4, although this should be interpreted as hypothesis-generating.