Clinical Characteristics and Risk Prediction of Heart Failure Patients in an Internal Medicine Department: Trajectories, Rehospitalization, and Mortality

Objective: To analyze the characteristics of patients with heart failure (HF) in an internal medicine department (IMD), define their clinical trajectories and develop a risk algorithm to predict mortality/rehospitalization. Meth-ods: Retrospective cohort study of 410 hospitalizations (28% readmissions / 280 patients) with acute HF discharged from our MID during 2023. Clinical diagnosis was reassured using the European Society of Cardiology age-related N-terminal proBNP (NT-proBNP) thresholds. Results: The cohort (mean age 82 years, 54% women) predomi-nantly had nonischemic heart disease (80%), HF with preserved ejection fraction (HFpEF, 69%), and a mean left ventricular EF of 53.7%. The most frequent comorbidities included hypertension (85%), diabetes (45%), atrial fibril-lation (44%) and almost half had ≥3 pre-existing non-cardiac diseases. In-hospital mortality reached 19.6% with a 30-day readmission rate of 9.9%. Three clinical trajectories were identified: single hospitalizations (n:169), rehospi-talizations with or without deaths (n :73), and deaths during the index admission (n:38). Markers of severity in-cluded advanced age, elevated NT-proBNP levels, secondary causes of HF, and the degree of reduction in renal function and hemoglobin value. The risk stratification model used was based on NT-proBNP, hemoglobin, LVEF, and gender (accuracy level of 72.7%). Conclusions: This internal medicine HF population was elderly, predomi-nantly female, with multiple comorbidities and high HFpEF prevalence. Severity indicators included renal function, hemoglobin, NT-proBNP, and the proportion of secondary HF causes. The developed algorithm may help identify patients at elevated risk for poor outcomes.