Objective This study sought to determine the prognostic impact of acute decompensated heart failure (ADHF) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). Background ADHF is a major complication in patients with heart failure (HF), however, the prognostic impact of ADHF in patients with HFmrEF has not yet been clarified. Methods Consecutive patients hospitalized with HFmrEF (i.e., left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) at one medical center were retrospectively included from 2016 to 2022. The prognosis of patients with ADHF was compared to those without (i.e., non-ADHF). The primary endpoint was all-cause mortality at 30 months (median follow-up). Among others, secondary endpoints included in-hospital mortality and HF-related rehospitalization at 30 months. Kaplan-Meier, multivariable Cox proportional regression and propensity-score matched analyses were performed. Results A total of 2,184 patients with HFmrEF were included with a rate of ADHF of 22.2%. ADHF was associated with a significantly increased risk of all-cause mortality (50% vs 26%; HR = 2.269; 95% CI 1.939-2.656; p = 0.001) and HF-related rehospitalization at 30 months (27% vs. 10%; HR = 3.250; 95% CI 2.565–4.118; p = 0.001), which was still evident after multivariable adjustment and propensity-score matching. Sub-analysis in the ADHF group indicated that previous ADHF during the 12 months prior to the index admission was associated with higher HF-related rehospitalization (41.7% vs. 23.0%; HR = 2.073; 95% CI 1.420–3.027; p = 0.001), but not all-cause mortality at 30 months (p = 0.264). Conclusion ADHF is common in HFmrEF and independently associated with 30-month all-cause mortality and HF-related rehospitalization.

中文翻译：

---

急性失代偿性心力衰竭对射血分数轻度降低的心力衰竭患者的预后影响

目的 本研究旨在确定急性失代偿性心力衰竭 (ADHF) 对射血分数轻度降低的心力衰竭 (HFmrEF) 患者的预后影响。背景 ADHF 是心力衰竭 (HF) 患者的主要并发症，然而，ADHF 对 HFmrEF 患者的预后影响尚未明确。方法 回顾性纳入 2016 年至 2022 年在一个医疗中心连续住院的 HFmrEF（即左心室射血分数 41-49% 和 HF 体征和/或症状）患者。比较 ADHF 患者与无 ADHF 患者的预后（即非ADHF）。主要终点是 30 个月时的全因死亡率（中位随访）。其中，次要终点包括 30 个月时的院内死亡率和心力衰竭相关的再住院率。进行了 Kaplan-Meier、多变量 Cox 比例回归和倾向评分匹配分析。结果共纳入HFmrEF患者2184例，ADHF发生率为22.2%。ADHF 与全因死亡率显着增加（50% vs 26%；HR = 2.269；95% CI 1.939-2.656；p = 0.001）和 30 个月时心力衰竭相关再住院风险显着增加相关（27% vs. 10%） ；HR = 3.250；95% CI 2.565–4.118；p = 0.001），在多变量调整和倾向得分匹配后仍然很明显。ADHF 组的子分析表明，指数入院前 12 个月内既往 ADHF 与心衰相关再住院率较高相关（41.7% vs. 23.0%；HR = 2.073；95% CI 1.420–3.027；p = 0.001 ），但不是 30 个月时的全因死亡率 (p = 0.264)。结论 ADHF 在 HFmrEF 中很常见，并且与 30 个月全因死亡率和 HF 相关的再住院独立相关。