Clinical Trajectories and Outcomes of Acute Heart Failure in Internal Medicine: A Real-World Single-Centre Study

Purpose: To analyze the clinical characteristics and outcomes of patients with acute heart failure (AHF) admitted to an internal medicine department (IMD), with a focus on their trajectories, risk factors, and rehospitalisation/mortality rate. Methods: This retrospective cohort study included 410 hospitalisations (280 patients; 28% readmissions) for AHF during 2023. Diagnosis was validated using the European Society of Cardiology age-specific NT-proBNP thresholds and echocardiographic criteria. Baseline clinical and laboratory data were analyzed, prognostic markers were identified, and a risk algorithm was developed. Results: Mean patient age was 82 years (54% women). Most cases involved nonischemic etiology (80%) and HF with preserved ejection fraction (HFpEF, 69%). Frequent comorbidities included hypertension (85%), diabetes (45%), atrial fibrillation (44%), and multiple noncardiac conditions. In-hospital mortality was 19.6%; 30-day readmission was 9.9%. Three clinical trajectories (index/first hospitalisation) were identified: single admission (n: 169), rehospitalisation (with/without death) (n: 73), and in-hospital death (n: 38). Prognostic markers included advanced age, elevated NT-proBNP, renal dysfunction, anemia, and non-cardiac cause of HF decompensation. Conclusions: This elderly IMD-HF cohort, mainly female and multimorbid, showed high HFpEF prevalence and adverse outcomes. NT-proBNP, renal function, haemoglobin, and non-cardiac causes of HF decompensation were key prognostic indicators.