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. 2025 Aug 9;15(1):29133.
doi: 10.1038/s41598-025-14100-1.

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

Mateusz Lucki  1 , Przemysław Mitkowski  2 , Ewa Lucka  3 , Marek Grygier  2 , Ewa Straburzyńska-Migaj  2 , Robert Morawiec  4 , Agnieszka Kapłon-Cieślicka  5 , Agata Galas  6 , Katarzyna Byczkowska  7 , Piotr Hamala  8 , Iwona Gorczyca-Głowacka  9 , Anna Furman-Niedziejko  10 , Dominika Klimczak-Tomaniak  11 , Agnieszka Major  12 , Adrian Stefański  13 , Mateusz Guzik  14 , Małgorzata Zachura  9 , Mateusz Staciwa  15 , Ewa Pierzchała  16 , Maciej Nadel  4 , Maciej Lesiak  2
Affiliations

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

Mateusz Lucki et al. Sci Rep. .

Abstract

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.

Keywords: Heart failure; Hospitalization; Length of stay; Prognostic indicators; Risk factors.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Software tools and image creation: All illustrations and figures were prepared by the authors using standard office software. Tables and Fig. 2 (chart) were created using Microsoft Excel, while Fig. 1 was created using Microsoft Word. Microsoft Word was also used for formatting and preparing the entire manuscript. Institutional review board statement: Data were collected using an electronic case report form (eCRF), in compliance with data protection regulations, including the GDPR. The study protocol was approved by the Bioethics Committee of the Medical University of Lodz (approval no. RNN/316/20/KE, with subsequent amendment KE/762/23), and the study was funded by the Polish Cardiac Society (contract no. CRU0120-KCKB-2023). Informed consent statement: Written informed consent was obtained from all participants.

Figures

Fig. 1
Fig. 1
Flowchart of study participant inclusion.
Fig. 2
Fig. 2
Forest Plot Illustrating Independent Risk and Protective Factors Associated with Prolonged Hospitalization in Patients with Acute Decompensated Heart Failure—Multivariate Logistic Regression Analysis. Blue color: protective factors, red color: risk factors, Statistical significance indicated by p-value. CI, Confidence Interval; ECG—Electrocardiography; KCCQ-12—Kansas City Cardiomyopathy Questionnaire; OR-Odds Ratio.
See this image and copyright information in PMC

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