Stoiculescu Flavia-Mihaela, Hădăreanu Diana-Ruxandra, Hădăreanu Călin-Dinu, Donoiu Ionuț, Istrătoaie Octavian, Raicea Victor-Cornel, Florescu Cristina
Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
Department of Cardiology, Clinical Emergency County Hospital of Craiova, Craiova, Romania.
Front Cardiovasc Med. 2025 Jul 25;12:1605102. doi: 10.3389/fcvm.2025.1605102. eCollection 2025.
This study aimed to identify predictors of heart failure (HF) rehospitalization and explore their association with mortality in patients with preserved (HFpEF), and mildly reduced (HFmrEF) ejection fraction, leading to the development of a multivariable risk prediction score.
We enrolled 1,022 HFpEF and HFmrEF inpatients discharged between January 2019 and May 2023. Demographic, clinical, biological, and imaging data were collected for analysis.
After a mean follow-up of 3.5 ± 1.4 years, 308 (30.1%) patients experienced HF rehospitalization. Univariable analysis revealed several parameters associated with HF rehospitalization, including age ( < 0.001), male sex ( = 0.015), type 2 diabetes mellitus (T2DM, = 0.016), arterial hypertension ( = 0.018), smoking ( = 0.029), NYHA class at discharge ( = 0.006), atrial fibrillation ( = 0.003), ischemic or congenital etiology ( = 0.011), serum sodium ( = 0.002), and several echocardiographic measures. Multivariate Cox regression revealed six independent predictors: age (HR = 0.98, < 0.001), T2DM (HR = 1.31, = 0.026), NYHA class (HR = 1.39, = 0.010), ischemic or congenital etiology (HR = 1.33, = 0.037), atrial fibrillation (HR = 0.65, = 0.001), and serum sodium level (HR = 0.97, = 0.005). These formed the AD2NNER (age, T2DM, serum natrium, NYHA class, etiology, rhythm) score, ranging from 0 to 9 points. Kaplan-Meier analysis confirmed reduced event-free survival in patients with scores ≥4 (log-rank = 0.005). Comparative Kaplan-Meier curves using an unweighted risk count (0-6) showed less distinct stratification. Subgroup analysis revealed robust score performance in HFpEF, but not HFmrEF alone. Higher AD2NNER scores were also associated with all-cause mortality.
The AD2NNER risk score is a simple, six-variable model that effectively predicts rehospitalization, and is also associated with mortality in patients with HFpEF and HFmrEF.
本研究旨在确定射血分数保留（HFpEF）和轻度降低（HFmrEF）的心力衰竭（HF）患者再次住院的预测因素，并探讨这些因素与死亡率的关联，以开发一个多变量风险预测评分。
我们纳入了2019年1月至2023年5月间出院的1022例HFpEF和HFmrEF住院患者。收集人口统计学、临床、生物学和影像学数据进行分析。
平均随访3.5±1.4年后，308例（30.1%）患者再次住院。单变量分析显示了几个与HF再次住院相关的参数，包括年龄（<0.001）、男性（=0.015）、2型糖尿病（T2DM，=0.016）、动脉高血压（=0.018）、吸烟（=0.029）、出院时的纽约心脏协会（NYHA）分级（=0.006）、心房颤动（=0.003）、缺血性或先天性病因（=0.011）、血清钠（=0.002）以及一些超声心动图测量指标。多变量Cox回归显示了六个独立预测因素：年龄（HR=0.98，<0.001）、T2DM（HR=1.31，=0.026）、NYHA分级（HR=1.39，=0.010）、缺血性或先天性病因（HR=1.33，=0.037）、心房颤动（HR=0.65，=0.001）和血清钠水平（HR=0.97，=0.005）。这些因素构成了AD2NNER（年龄、T2DM、血清钠、NYHA分级、病因、心律）评分，范围为0至9分。Kaplan-Meier分析证实，评分≥4的患者无事件生存期缩短（对数秩检验=0.005）。使用未加权风险计数（0-6）的比较Kaplan-Meier曲线显示分层不太明显。亚组分析显示，该评分在HFpEF患者中表现稳健，但单独在HFmrEF患者中并非如此。较高的AD2NNER评分也与全因死亡率相关。
AD2NNER风险评分是一个简单的六变量模型，能有效预测再次住院情况，并且与HFpEF和HFmrEF患者的死亡率也相关。
