Abstract P316: Sleep Timing Correlates With Incident Congestive Heart Failure: A Community-based Cohort Study

Introduction: Previous studies have suggested that sleep habits were associated with cardiovascular risk factors. However, there is no evidence about the relationship between sleep timing and congestive heart failure (CHF). Hypothesis: We assessed the hypothesis that the bedtime and wake-up time on weekday and weekend may be associated with incident CHF. Methods: From the Sleep Heart Health Study (registration number, NCT00005275), participants without previous heart failure were enrolled in the present prospective study. Sleep timing including bedtime and wake-up time on weekday and weekend was acquired from a self-reported Sleep Habits Questionnaire. Bedtime on weekdays and weekend was divided into >24:00, 23:01 to 24:00, 22:01 to 23:00 and ≤22:00. Wake-up time on weekdays and weekend was classified as >8:00, 7:01 to 8:00, 6:01 to 7:00 and ≤6:00. Further subgroup analysis was conducted according to sleep duration of <6h, 6-8h and >8h. Participants were followed up until the first CHF diagnosed between the date of the completed questionnaire and the final censoring date. Cox regression analysis was used to investigate the association between sleep timing and CHF. Results: A total of 4765 participants including 2207 males and 2558 females with a mean age of 63.6±11.0 years were recruited in the study. During the mean follow-up period of 11 years, 519 participants were diagnosed with CHF. The incidence of CHF in participants with weekday bedtime at >24:00 was 15.6% (69 of 441), which is higher than those with bedtime at 23:01 to 24:00 [12.7% (166 of 1306)], 22:01 to 23:00 [7.0% (128 of 1837)], and ≤22:00 [13.2% (156 of 1181)]. Participants with wake-up time on weekday at > 8:00 also had the highest incidence of CHF [19.7% (45 of 229)] than those with wake-up time at 7:01 to 8:00 [14.2% (89 of 627)], 6:01 to 7:00 [11.5% (171 of 1485)], and ≤6:00 [8.8% (214 of 2424)]. After multivariate Cox regression analyses, individuals with bedtime at >24:00 on weekdays was associated with a higher incidence of CHF (HR 1.559, 95% CI 1.151-2.113, P = 0.004) than those with bedtime at 22:01 to 23:00. And compared with participants with wake-up time at ≤6:00, those with wake-up time at > 8:00 also had an increased risk of incident CHF (HR 1.525, 95% CI 1.074-2.166, P =0.018). After further subgroup analysis, the association between bedtime at >24:00 on weekdays and incident CHF were strengthened in the participants with 6-8 hours’ sleep duration (HR 2.087, 95% CI 1.446-3.013, P <0.001). Conclusion: In conclusion, late bedtime (>24:00) and late wake-up time (>8:00) on weekdays may correlate with an increased risk of CHF. The impact of sleep timing on incident cardiovascular diseases may be worth further prospective study.

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Myocardial reperfusion reverses the J-curve association of cardiovascular risk and diastolic blood pressure in patients with left ventricular dysfunction and heart failure after myocardial infarction: insights from the EPHESUS trial

European Heart Journal ◽

10.1093/eurheartj/ehaa132 ◽

2020 ◽

Vol 41 (17) ◽

pp. 1673-1683 ◽

Cited By ~ 5

Author(s):

Michael Böhm ◽

João Pedro Ferreira ◽

Felix Mahfoud ◽

Kevin Duarte ◽

Bertram Pitt ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Blood Pressure ◽

Diastolic Blood Pressure ◽

Cox Regression ◽

Cardiovascular Death ◽

Left Ventricular ◽

Coronary Perfusion ◽

Increased Risk ◽

The Impact

Abstract Aims The described association of low diastolic blood pressure (DBP) with increased cardiovascular outcomes could be due to reduced coronary perfusion or is simply due to reverse causation. If DBP is physiologically relevant, coronary reperfusion after myocardial infarction (MI) might influence DBP–risk association. Methods and results The relation of achieved DBP with cardiovascular death or cardiovascular hospitalization, cardiovascular death, and all-cause death was explored in 5929 patients after acute myocardial infarction (AMI) with impaired left ventricular function, signs and symptoms of heart failure, or diabetes in the EPHESUS trial according to their reperfusion status. Cox regression models were used to assess the impact of reperfusion status on the association of DBP and systolic blood pressure (SBP) with outcomes in an adjusted fashion. In patients without reperfusion, lower DBP <70 mmHg was associated with increased risk for all-cause death [adjusted hazard ratios (HRs) 1.80, 95% confidence interval (CI) 1.41–2.30; P < 0.001], cardiovascular death (HR 1.70, 95% CI 1.3–3.22; P < 0.001), cardiovascular death or cardiovascular hospitalization (HR 1.54, 95% CI 1.26–1.87; P < 0.001). In patients with reperfusion, the risk increase at low DBP was not observed. At low SBP, risk increased independently of reperfusion. A sensitivity analysis in the subgroup of patients with optimal SBP of 120–130 mmHg showed again risk reduction of reperfusion at low DBP. Adding the treatment allocation to eplerenone or placebo into the models had no effects on the results. Conclusion Patients after AMIs with a low DBP had an increased risk, which was sensitive to reperfusion therapy. Low blood pressure after MI identifies in patients with particular higher risk. These data support the hypothesis that low DBP in patients with stenotic coronary lesions is associated with risk, potentially involving coronary perfusion pressure and the recommendations provided by guidelines suggesting lower DBP boundaries for these high-risk patients.

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Impact of Congestive Heart Failure and Role of Cardiac Biomarkers in COVID-19 patients: A Systematic Review and Meta-Analysis

10.1101/2020.07.06.20147421 ◽

2020 ◽

Author(s):

Tarun Dalia ◽

Shubham Lahan ◽

Sagar Ranka ◽

Prakash Acharya ◽

Archana Gautam ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Disease Severity ◽

Troponin I ◽

Severe Disease ◽

Cardiac Injury ◽

Cardiac Biomarkers ◽

Pooled Data ◽

Increased Risk ◽

The Impact

Background: Coronavirus disease 2019 (COVID-19) has been reported to cause worse outcomes in patients with underlying cardiovascular disease, especially in patients with acute cardiac injury, which is determined by elevated levels of high-sensitivity troponin. There is a paucity of data on the impact of congestive heart failure (CHF) on outcomes in COVID-19 patients. Methods: We conducted a literature search of PubMed/Medline, EMBASE, and Google Scholar databases from 11/1/2019 till 06/07/2020, and identified all relevant studies reporting cardiovascular comorbidities, cardiac biomarkers, disease severity, and survival. Pooled data from the selected studies were used for metanalysis to identify the impact of risk factors and cardiac biomarker elevation on disease severity and/or mortality. Results: We collected pooled data on 5,967 COVID-19 patients from 20 individual studies. We found that both non-survivors and those with severe disease had an increased risk of acute cardiac injury and cardiac arrhythmias, our pooled relative risk (RR) was - 8.52 (95% CI 3.63-19.98) (p<0.001); and 3.61 (95% CI 2.03-6.43) (p=0.001), respectively. Mean difference in the levels of Troponin-I, CK-MB, and NT-proBNP was higher in deceased and severely infected patients. The RR of in-hospital mortality was 2.35 (95% CI 1.18-4.70) (p=0.022) and 1.52 (95% CI 1.12-2.05) (p=0.008) among patients who had pre-existing CHF and hypertension, respectively. Conclusion: Cardiac involvement in COVID-19 infection appears to significantly adversely impact patient prognosis and survival. Pre-existence of CHF and high cardiac biomarkers like NT-pro BNP and CK-MB levels in COVID-19 patients correlates with worse outcomes. Keywords: Acute cardiac injury; cardiac arrhythmia; mortality risk; cardiac biomarkers, COVID-19.

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Sleep Timing May Predict Congestive Heart Failure: A Community‐Based Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.120.018385 ◽

2021 ◽

Vol 10 (6) ◽

Author(s):

Bin Yan ◽

Ruohan Li ◽

Jiamei Li ◽

Xuting Jin ◽

Fan Gao ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Cohort Study ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Health Study ◽

Sleep Timing ◽

Cox Proportional Hazards Models ◽

Increased Risk

Background Previous studies have suggested that sleep timing is associated with cardiovascular risk factors. However, there is no evidence on the relationship between sleep timing and congestive heart failure (CHF). We aimed to examine this relationship in this study. Methods and Results We recruited 4765 participants (2207 men; mean age, 63.6±11.0 years) from the SHHS (Sleep Heart Health Study) database in this multicenter prospective cohort study. Follow‐up was conducted until the first CHF diagnosis between baseline and the final censoring date. Sleep timing (bedtimes and wake‐up times on weekdays and weekends) was based on a self‐reported questionnaire. Cox proportional hazard models were constructed to investigate the association between sleep timing and CHF. During the mean follow‐up period of 11 years, 519 cases of CHF (10.9%) were reported. The multivariable Cox proportional hazards models revealed that participants with weekday bedtimes >12:00 am (hazard ratio [HR], 1.56; 95% CI, 1.15–2.11; P =0.004) and from 11:01 pm to 12:00 am (HR, 1.25; 95% CI, 1.00–1.56; P =0.047) had an increased risk of CHF compared with those with bedtimes from 10:01 pm to 11:00 pm . After stratified analysis, the association was intensified in participants with a self‐reported sleep duration of 6 to 8 hours. Furthermore, wake‐up times >8:00 am on weekdays (HR, 1.53; 95% CI, 1.07–2.17; P =0.018) were associated with a higher risk of incident CHF than wake‐up times ≤6:00 am . Conclusions Delayed bedtimes (>11:00 pm ) and wake‐up times (>8:00 am ) on weekdays were associated with an increased risk of CHF.

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The impact of central obesity on the risk of hospitalization or death due to heart failure in type 1 diabetes: a 16-year cohort study

Cardiovascular Diabetology ◽

10.1186/s12933-021-01340-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Erika B. Parente ◽

Valma Harjutsalo ◽

Carol Forsblom ◽

Per-Henrik Groop ◽

Keyword(s):

Heart Failure ◽

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

Central Obesity ◽

Cox Regression ◽

General Obesity ◽

Increased Risk ◽

Incident Cases ◽

The Impact

Abstract Background Obesity and type 2 diabetes are well-known risk factors for heart failure (HF). Although obesity has increased in type 1 diabetes, studies regarding HF in this population are scarce. Therefore, we investigated the impact of body fat distribution on the risk of HF hospitalization or death in adults with type 1 diabetes at different stages of diabetic nephropathy (DN). Methods From 5401 adults with type 1 diabetes in the Finnish Diabetic Nephropathy Study, 4668 were included in this analysis. The outcome was HF hospitalization or death identified from the Finnish Care Register for Health Care or the Causes of Death Register until the end of 2017. DN was based on urinary albumin excretion rate. A body mass index (BMI) ≥ 30 kg/m2 defined general obesity, whilst WHtR ≥ 0.5 central obesity. Multivariable Cox regression was used to explore the associations between central obesity, general obesity and the outcome. Then, subgroup analyses were performed by DN stages. Z statistic was used for ranking the association. Results During a median follow-up of 16.4 (IQR 12.4–18.5) years, 323 incident cases occurred. From 308 hospitalizations due to HF, 35 resulted in death. Further 15 deaths occurred without previous hospitalization. The WHtR showed a stronger association with the outcome [HR 1.51, 95% CI (1.26–1.81), z = 4.40] than BMI [HR 1.05, 95% CI (1.01–1.08), z = 2.71]. HbA1c [HR 1.35, 95% CI (1.24–1.46), z = 7.19] was the most relevant modifiable risk factor for the outcome whereas WHtR was the third. Individuals with microalbuminuria but no central obesity had a similar risk of the outcome as those with normoalbuminuria. General obesity was associated with the outcome only at the macroalbuminuria stage. Conclusions Central obesity associates with an increased risk of heart failure hospitalization or death in adults with type 1 diabetes, and WHtR may be a clinically useful screening tool.

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Comparison of incidence rates and risk factors of heart failure between two male cohorts born 30 years apart

Heart ◽

10.1136/heartjnl-2019-316059 ◽

2020 ◽

Vol 106 (21) ◽

pp. 1672-1678

Author(s):

Constantinos Ergatoudes ◽

Per-Olof Hansson ◽

Kurt Svärdsudd ◽

Annika Rosengren ◽

Erik Östgärd Thunström ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Physical Inactivity ◽

Cox Regression ◽

Incidence Rates ◽

Cox Regression Analysis ◽

Increased Risk ◽

The Impact

ObjectiveTo compare two cohorts of middle-aged men from the general population born 30 years apart for incidence and predictors of heart failure (HF).MethodsTwo population samples of men, born in 1913 (n=855) and in 1943 (n=797), were examined at 50 years of age and followed up for 21 years (1963–1994 and 1993–2014). Cox regression analysis was used to examine the impact of different factors on the risk of developing HF.ResultsEighty men born in 1913 (9.4%) and 42 men born in 1943 (5.3%) developed HF during follow-up; adjusted HRs comparing the two cohorts (born 1943 vs 1913) were: 0.46 (95% CI 0.28 to 0.74, p=0.002). In both cohorts, higher body mass index, higher diastolic blood pressure, treatment for hypertension, onset of either atrial fibrillation (AF), ischaemic heart disease and diabetes mellitus were associated with higher risk of HF. Higher heart rate was associated with an increased risk only in men born in 1913, whereas higher systolic blood pressure (SBP), smoking, higher glucose, higher cholesterol and physical inactivity were associated with an increased risk in men born in 1943. AF contributed higher risk of incident HF, whereas SBP and physical inactivity contributed lower risk in men born in 1943 compared with men born in 1913.ConclusionsMen born in 1943 had half the risk of HF after their 50s than those born 30 years earlier. AF, obesity, ischaemic heart disease, diabetes and hypertension remain important precursors of HF.

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Determinants of mortality in a large group of hemodialysis patients hospitalized for COVID-19

BMC Nephrology ◽

10.1186/s12882-021-02233-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kenan Turgutalp ◽

Savas Ozturk ◽

Mustafa Arici ◽

Necmi Eren ◽

Numan Gorgulu ◽

...

Keyword(s):

Heart Failure ◽

Mechanical Ventilation ◽

Congestive Heart Failure ◽

Intensive Care ◽

Platelet Count ◽

Cox Regression ◽

Clinical Laboratory ◽

Clinical Severity ◽

Large Group ◽

Increased Risk

Abstract Background Maintenance hemodialysis (MHD) patients are at increased risk for coronavirus disease 2019 (COVID-19). The aim of this study was to describe clinical, laboratory, and radiologic characteristics and determinants of mortality in a large group of MHD patients hospitalized for COVID-19. Methods This multicenter, retrospective, observational study collected data from 47 nephrology clinics in Turkey. Baseline clinical, laboratory and radiological characteristics, and COVID-19 treatments during hospitalization, need for intensive care and mechanical ventilation were recorded. The main study outcome was in-hospital mortality and the determinants were analyzed by Cox regression survival analysis. Results Of 567 MHD patients, 93 (16.3%) patients died, 134 (23.6%) patients admitted to intensive care unit (ICU) and 91 of the ones in ICU (67.9%) needed mechanical ventilation. Patients who died were older (median age, 66 [57–74] vs. 63 [52–71] years, p = 0.019), had more congestive heart failure (34.9% versus 20.7%, p = 0.004) and chronic obstructive pulmonary disease (23.6% versus 12.7%, p = 0.008) compared to the discharged patients. Most patients (89.6%) had radiological manifestations compatible with COVID-19 pulmonary involvement. Median platelet (166 × 103 per mm3 versus 192 × 103 per mm3, p = 0.011) and lymphocyte (800 per mm3 versus 1000 per mm3, p < 0.001) counts and albumin levels (median, 3.2 g/dl versus 3.5 g/dl, p = 0.001) on admission were lower in patients who died. Age (HR: 1.022 [95% CI, 1.003–1.041], p = 0.025), severe-critical disease clinical presentation at the time of diagnosis (HR: 6.223 [95% CI, 2.168–17.863], p < 0.001), presence of congestive heart failure (HR: 2.247 [95% CI, 1.228–4.111], p = 0.009), ferritin levels on admission (HR; 1.057 [95% CI, 1.006–1.111], p = 0.028), elevation of aspartate aminotransferase (AST) (HR; 3.909 [95% CI, 2.143–7.132], p < 0.001) and low platelet count (< 150 × 103 per mm3) during hospitalization (HR; 1.864 [95% CI, 1.025–3.390], p = 0.041) were risk factors for mortality. Conclusion Hospitalized MHD patients with COVID-19 had a high mortality rate. Older age, presence of heart failure, clinical severity of the disease at presentation, ferritin level on admission, decrease in platelet count and increase in AST level during hospitalization may be used to predict the mortality risk of these patients.

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Association Between Depression and Clinical Outcomes in Patients With Hypertrophic Cardiomyopathy

Journal of the American Heart Association ◽

10.1161/jaha.120.019071 ◽

2021 ◽

Author(s):

Hui‐Lin Hu ◽

Hao Chen ◽

Chun‐Yan Zhu ◽

Xin Yue ◽

Hua‐Wei Wang ◽

...

Keyword(s):

Heart Failure ◽

Hypertrophic Cardiomyopathy ◽

Clinical Outcomes ◽

Cox Regression ◽

Cox Regression Analysis ◽

Diagnostic And Statistical Manual ◽

Kaplan Meier ◽

Increased Risk ◽

Artery Disease ◽

The Impact

Background Hypertrophic cardiomyopathy (HCM) is considered to be the most common cause of sudden death in young people and is associated with an elevated risk of mood disorders. Depression has emerged as a critical risk factor for development and progression of coronary artery disease; however, the association between depression and HCM outcomes is less clear. We sought to examine the impact of depression on clinical outcomes in patients with HCM. Methods and Results Between January 2014 and December 2017, 820 patients with HCM were recruited and followed for an average of 4.2 years. End points were defined as sudden cardiac death (SCD) events and HCM‐related heart failure events. A Chinese version of the Structured Clinical Interview followed the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and was used to diagnose depression. During the follow‐up period, SCD events occurred in 75 individuals (21.8 per 1000 person‐years), and HCM‐related heart failure events developed in 149 individuals (43.3 per 1000 person‐years). Kaplan–Meier cumulative incidence curves showed a significant association of depression disorders with SCD events (log‐rank P =0.001) and HCM‐related heart failure events (log‐rank P =0.005). A multivariate Cox regression analysis indicated that depression was an independent predictor of SCD events and HCM‐related heart failure events (41.9 versus 21.7 per 1000 person‐years; adjusted hazard ratio [HR], 1.9; 95% CI, 1.6–2.3; P <0.001; and 69.9 versus 38.6 per 1000 person‐years; HR, 1.8; 95% CI, 1.6–2.1; P <0.001, respectively). Conclusions Depression is common among patients with HCM. The diagnosis of depression is significantly and independently associated with an increased risk of SCD events and heart failure events in patients with HCM.

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Effects of Quarantine Due to the COVID-19 on Sleep Duration and Quality in Algerians

Acta Facultatis Educationis Physicae Universitatis Comenianae ◽

10.2478/afepuc-2020-0015 ◽

2020 ◽

Vol 60 (2) ◽

pp. 182-193

Author(s):

Kacem Abdelhadi ◽

Houar Abdelatif ◽

Zerf Mohamed ◽

Bengoua Ali

Keyword(s):

Statistical Analysis ◽

Sleep Quality ◽

Sleep Duration ◽

Online Survey ◽

Public Awareness ◽

Italian Version ◽

Sleep Timing ◽

Algerian Population ◽

Significant Change ◽

The Impact

SummaryThis study tests the impact of COVID-19 on sleep of Algerian population before and during the COVID-19 quarantine by an estimated online survey, adapted from the PSQI Italian version. Including 1210 participants (age between 18-60 years old). The statistical analysis was carried out using SPSS version 22.0 software. Our results showed a significant change in sleeping quality during quarantine, the sleep timing markedly changed, we also noticed additional use of sleeping medications. Algerian scientists recommend to build public awareness and to provide necessary information regarding Algerian sleep quality, especially for Algerian adults.

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Biochemical Markers in Patients with Readmission for Congestive Heart Failure

Revista de Chimie ◽

10.37358/rc.18.7.6395 ◽

2018 ◽

Vol 69 (7) ◽

pp. 1687-1691

Author(s):

Razan Al Namat ◽

Mihai Constantin ◽

Ionela Larisa Miftode ◽

Andrei Manta ◽

Antoniu Petris ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Rural Areas ◽

Discharge Planning ◽

Difficult Problem ◽

Uncontrolled Hypertension ◽

Medical Attention ◽

Family Doctors ◽

Increased Risk ◽

Risk Patients

Repetitive or recurrent hospitalizations are a general major health issue in patients with chronic disease. Congestive heart failure, is associated with a high incidence and presence of early rehospitalization, but variables in order to identify patients at increased risk and also an analysis of potentially remediable factors contributing to readmission have not been previously reported and it remains still a difficult problem. We retrospectively assessed 100 patients aged between 48-85 years old, of which 75% were men, who had been hospitalized with documentation of congestive heart failure in St. Spiridon County Emergency Hospital. They were hospitalized between 2010-2017. Even if recurrent heart failure was the most common cause for readmission or rehospitalization, other cardiac disorders and noncardiac illnesses were also accounted for readmission. Predictive factors of an increased probability of readmission included prior patient�s medical heart failure history, heart failure decompensation precipitated or accelerated by an ischaemic episode, atrial fibrillation or uncontrolled hypertension. Factors contributing to preventable readmissions included noncompliance with medications or diet, inadequate discharge planning or follow-up, failure of both social support system and the seek of a promp medical attention when symptoms reappeared. We also identified an inappropriate colaboration with family doctors especially for the patients from rural areas. Patients were more likely to cite side effects of prescribed medications rather than nonadherence as a precipitating factor for readmission. Thus, we can appreciate that early rehospitalization in patients with congestive heart failure may be avoidable in up to 50% of cases. Identification of high risk patients is possible and also necessary shortly after admission in order to identify nonpharmacological interventions designed to decrease readmission frequency.

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Rehospitalization as a predictor of mortality in Polish population of heart failure patients-national registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.0967 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Zaleska-Kociecka ◽

K Witczak ◽

K Bartolik ◽

D Was ◽

A Kleinork ◽

...

Keyword(s):

Heart Failure ◽

Cox Regression ◽

National Registry ◽

Funding Source ◽

Polish Population ◽

The European Union ◽

Related Factors ◽

Comorbidity Burden ◽

All Cause Mortality ◽

The Impact

Abstract Background High mortality risk in heart failure (HF) is related to repeat HF hospitalizations but also individual patient characteristics. Purpose To evaluate the impact of HF re-/hospitalizations and patient-related factors (sex, HF etiology, age, comorbidity) on all-cause mortality. Methods Our study represents one of the most extensive retrospective cohort analyses consisting of 1,686,861 adult Polish HF patients who presented into public health system in years 2013–2018. It is a part of a nationwide National Health Fund registry covering out- and in-patient data for the entire Polish population (38,495,659 in 2013) since 2009. HF hospitalizations were extracted using ICD-10 coding, whereas the comorbidity was evaluated by means of Charlson Comorbidity Index (CCI). Results In years 2013–2018 the absolute number of HF hospitalizations in Poland grew by 33% to 264,808 in 2018, whereas the number of rehospitalizations increased 1.5-fold to reach 137,708 in 2018. In fact, nearly half of HF patients (n=817,432; 48.5%) experienced at least one hospitalization, while 15.4% (n=259,868) were rehospitalized during the study period. After initial hospitalization the readmission rate due to HF/all circulatory diseases at 30, 60, 180, 360, and 720 days was 10.4%/15.1%, 21.2%/28.3%, 43.9%/52.8%, 62%/70.4%, and 81%/87%, respectively. As compared to patients who were hospitalized just once, those who underwent at least one rehospitalization were more often female (p<0.001), slightly older (p<0.001), and with higher burden of comorbidities based on CCI (p<0.001). Patient survival was highly dependent on hospitalization frequency (Fig. 1). Mean survival rate at day 720 was 66.4%, 59.8%, 54.9%, 51%, and 43.9% for 1st, 2nd, 3rd, 4th, and ≥5th hospitalization, respectively. After adjusting for age, sex, etiology (ischemic/non-ischemic) and CCI using a multivariate stratified Cox regression model, the estimated hazard ratios (HR) for all-cause mortality amounted to 1.22 (95% CI: 1.21–1.23, p<0.001) for 2nd, 1.4 (95% CI: 1.39–1.42, p<0.001) for 3rd, 1.58 (95% CI: 1.56–1.6, p<0.001) for 4th, and 1.97 (95% CI: 1.95–1.98 p<0.001) for 5th and subsequent hospitalizations, as compared to the first hospitalization. Conclusions Hospitalization rate in Poland is alarmingly high. Repeat HF hospitalizations strongly predict mortality rate for HF patients even after adjustment for age, sex, etiology, and comorbidity burden. Figure 1. Kaplan-Meier for survival post hosp. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): The project is co-financed by the European Union from the European Social Fund under the Operational Programme Knowledge Education Development and it is being carried out by the Analyses and Strategies Department of the Polish Ministry of Health.

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