Résumé
Aims: To assess the prognostic impact of both the frequency and timing of prior heart failure (HF) hospitalisations on outcomes in patients with reduced left ventricular ejection fraction (LVEF).Methods and results : This nationwide retrospective cohort study used the French national health insurance database to identify 730,052 adults with HF in 2017. A validated algorithm classified 226,747 as HF with reduced LVEF (<45 %), of whom 54,504 (24 %) had at least one HF-related hospitalisation >24 h within the preceding 24 months (worsening HF group). Patients were stratified by (1) time since the last HF hospitalisation (0–6, 6–24 months) and (2) number of hospitalisations (1, 2, ≥3). Mean age was 76 ± 15 years. Prior HF hospitalisation was the strongest predictor of mortality among all variables. After multivariable adjustment, prior hospitalisation was associated with increased risk of all-cause death (HR 1.61, 95 % CI 1.56–1.65), all-cause hospitalisation (HR 1.34, 95 % CI 1.32–1.37), and recurrent HF hospitalisation (HR 2.51, 95 % CI 2.43–2.59). Risks were greatest when the most recent hospitalisation occurred within 6 months and rose progressively with the number of prior events.Conclusion : In patients with reduced LVEF, both recent and recurrent HF hospitalisations are strong predictors of mortality and rehospitalisation. These two simple markers identify highly vulnerable patients and should trigger intensified follow-up, optimisation of guideline-directed therapies, and implementation of transitional care and remote monitoring programs.