Left atrial function is a predictor of 90-day readmissions in patients with a first hospitalization for heart failure

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Abstract Aim Heart failure (HF) readmissions are frequent and have important prognostic consequences. LACE index is a tool that estimates the risk of rehospitalization in different clinical scenarios, and has shown moderate discriminatory performance in HF. Our aim was to analyze the association of different clinical and echocardiographic parameters with the risk of 90-day readmissions and to address the performance of the LACE index in our cohort of patients with a first HF hospitalization. Methods Prospective cohort of patients with a first HF hospitalization in a tertiary care center between 2020 and 2022. Clinical, analytical and echocardiographic variables were collected at the time of admission. The primary outcome was 90-day readmissions for HF. Results The mean age of our cohort (n=178) was 73.4 (13) years and 69 (39%) were female. Mean LVEF was 43.8% (15). The prevalence of comorbidities was high: arterial hypertension 71%, diabetes 39%, obesity 29%, atrial fibrillation 25%, and chronic kidney disease 15%. Mean LACE index was 10 (2.8), which corresponds to a high risk of readmission. The incidence of 90-day readmission was 14%. Variables significantly associated with readmission were female sex, history of AF, right ventricular-arterial coupling index, left atrial stiffness, creatinine clearance, and systolic arterial pressure at discharge (Figure 1). A multivariable logistic regression analysis showed that atrial stiffness (OR 1.71; p=0.042) and creatinine clearance (OR 0.95; p=0.066) were the only two independent predictors of readmissions. A model comprising these 2 variables had an area under the ROC curve of 0.758 (95% CI: 0.65-0.84), and was statistically superior to LACE index (AUC 0.55; 95% CI: 0.48-0.63); p<0.005 (Figure 2). Conclusions In a cohort of patients with a first hospitalization for HF and high burden of comorbidities, a simple model which takes into account renal function and left atrial function showed good diagnostic yield for predicting 90-day readmissions. Logistic regression analysis ROC curves

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