Clinical characteristics and outcomes in patients admitted with acute heart failure: a comparison of de novo vs. acute decompensated chronic heart failure

Abstract Background Acute heart failure (AHF) presents as either new-onset heart failure (de novo AHF) or acute decompensation of chronic heart failure (ADCHF). Studies comparing the detailed cardiac characteristics of these groups remain limited. Purpose We sought to identify clinical characteristics and compare mortality and AHF readmission outcomes in patients with de novo AHF and ADCHF. Methods In a prospective, two-centre observational cohort study, adults hospitalised with clinical signs of AHF were enrolled from 2022 to 2024. Echocardiography, 8-zone lung ultrasound (LUS), and laboratory tests were performed shortly after admission. Medical chart reviews provided a detailed medical history at the time of admission. We analysed the composite outcome of AHF readmission or all-cause mortality at 90 and 180 days after discharge. Results A total of 567 patients admitted with AHF were prospectively included (mean age 78.2 ± 11.6; 43.7% female). Among these, 299 (52.7%) had de novo AHF and 268 (47.3%) had ADCHF. Compared to ADCHF, patients with de novo AHF were younger (77.1 ± 12.1 vs. 79.4 ± 10.8 years, p=0.020), had fewer comorbidities (Figure 1), including a lower prevalence of atrial fibrillation (57.5% vs. 72.8%, p0.001), and were more likely to present with acute coronary syndrome as AHF aetiology (19.4% vs. 6.0%, p0.001). On echocardiography, patients with ADCHF had higher filling pressures (E/e’: 18.0 ± 8.69 vs. 15.5 ± 8.17, p=0.002), larger left atrial volume index (41.6 ± 18.4 vs. 36.2 ± 15.2 mL/m2, p=0.005), and lower tricuspid annular plane systolic excursion (1.81 ± 0.39 vs. 1.89 ± 0.35 cm, p=0.023). There was no significant difference in left ventricular ejection fraction between groups (ADCHF: 37.8% vs. de novo AHF: 37.4%, p=0.749). On LUS, patients with ADCHF presented with a higher B-line count compared to patients with de novo AHF (10 ± 9 vs. 7 ± 8, p0.001). At 90- and 180-days post-discharge, 140 (24.7%) and 185 (32.6%) patients were either readmitted with AHF or died. Although 90-day outcome rates were comparable (de novo AHF: 21.7% vs. ADCHF: 28.0%, p=0.10), patients with ADCHF had worse 180-day outcomes (38.4% vs. 27.4%, p=0.039). In univariable Cox regression, ADCHF was associated with a higher 180-day composite outcome risk (HR 1.51, 95% CI 1.13–2.02, p=0.005) (Figure 2). This association remained after adjusting for age and comorbidities (HR 1.45, 95% CI 1.05–1.99, p=0.022). Conclusions In this real-life prospective cohort of patients admitted with clinical signs of AHF, cases of de novo AHF and ADCHF were evenly distributed. Patients with de novo AHF tended to be younger, had fewer comorbidities, better diastolic and right ventricular function, and less pulmonary congestion on LUS. While short-term outcomes were similar, ADCHF patients had significantly higher 180-day readmission or mortality rates. ADCHF was independently associated with a higher risk of the 180-day composite outcome.Figure 1 Figure 2