Risk factors for prolonged hospitalization in acute decompensated heart failure from the HEROES study

This study, part of the HEROES project (HEart failure Risk factOrs and patiEnt Stratification), aimed to identify clinical, laboratory, functional, and treatment-related factors associated with hospitalization duration (above and below 8 days) in patients admitted for acute decompensated heart failure (ADHF). We analyzed 562 Caucasian patients hospitalized due to acute decompensated heart failure (ADHF), divided into two groups based on length of stay (LOS): ≤ 8 days (n = 287; 51.07%) and > 8 days (n = 275; 48.93%). In the ≤ 8 days group, 203 patients (70.73%) were male, while in the > 8 days group, 202 patients (73.45%) were male. Data on sociodemographic features, clinical characteristics, laboratory and imaging findings, treatment details, and patient-reported health status (KCCQ-12) were collected. Multivariate logistic regression identified independent predictors of prolonged hospitalization. Patients with longer LOS had higher NYHA class (p < 0.001), greater comorbidity burden (p = 0.0019), longer intensive cardiac care unit (ICCU) stay (p < 0.001), and higher in-hospital mortality (p = 0.0006). They also showed elevated NT-proBNP (p < 0.0001), procalcitonin (p = 0.03), and creatinine (p = 0.0002), and lower hemoglobin (p = 0.004), hematocrit (p = 0.014), and sodium (p = 0.0325). In the multivariate analysis, independent predictors of prolonged hospitalization included treatment with norepinephrine (OR = 18.41), dopamine (OR = 8.62), and oral iron therapy (OR = 3.25). Conversely, protective factors associated with a reduced risk of prolonged hospitalization were higher KCCQ-12 scores (OR = 0.98), higher systolic blood pressure at admission (OR = 0.99), and prior statin use (OR = 0.56). In the HEROES study, prolonged hospitalization among ADHF patients was associated with more severe symptoms of heart failure decompensation higher comorbidity load, impaired functional and laboratory parameters and need for longer stay in ICCU. Early identification of high-risk patients may facilitate personalized management and optimize healthcare resource utilization.