Rehospitalisation Patterns in Very Old Adults with Heart Failure Managed Within an Integrated Cardiogeriatric Post-Discharge Care Pathway: The REACT-HF Study

Abstract

Purpose: Very old adults with heart failure (HF) experience high rehospitalisation rates related to multimorbidity, functional vulnerability, and complex care transitions. Empirical evidence on factors associated with rehospitalisation in very old adults with HF managed within integrated post-discharge care pathways remains limited. This study aimed to describe rehospitalisation patterns and associated clinical markers in very old patients with HF managed within an integrated cardiogeriatric post-discharge pathway. Patients and methods: This retrospective single-centre cohort included patients aged ≥65 years hospitalised for acute HF and enrolled at discharge in an integrated cardiogeriatric pathway combining structured remote monitoring, rapid-access day-hospital services and coordinated outpatient follow-up (April 2023–August 2025). Analyses were restricted to patients who survived the early post-discharge period and had available 12-month follow-up data, in order to assess rehospitalisation status at predefined post-discharge time points. The primary outcome was unplanned HF rehospitalisation at 12 months; secondary outcomes included rehospitalisation at 3 and 6 months, predictors of rehospitalisation and hospital length of stay. Exploratory multivariable logistic regression analyses were performed. Results: Among 255 very old patients with available 12-month follow-up data (median age 87 years), rehospitalisation rates were 9.8% at 3 months, 16.1% at 6 months and 24.7% at 12 months. Higher loop diuretic dose was associated with rehospitalisation at 3 months. At 6 months, moderate-to-severe mitral regurgitation, higher diuretic dose and absolute iron deficiency were independently associated with rehospitalisation. At 12 months, moderate-to-severe mitral regurgitation, iron deficiency and chronic obstructive pulmonary disease were independently associated. These findings apply to patients who survived the early post-discharge period and had sufficient follow-up data, rather than to an unselected acute HF population. Conclusion: In very old patients with HF and available longitudinal follow-up, higher loop diuretic dose, iron deficiency, moderate-to-severe mitral regurgitation, and COPD were associated with rehospitalisation status at predefined time horizons. These exploratory findings suggest that routinely available clinical markers may help support risk-stratified follow-up in advanced-age HF populations.