Abstract 4373374: Impact of Chronic Venous Insufficiency on Morbidity and Mortality Among Patients Hospitalized for Heart Failure: A Propensity-Matched Real-World Cohort Study

Background: Chronic venous insufficiency (CVI), characterized by venous valve incompetence and vein wall dysfunction leading to venous stasis and hypertension, affects up to 40% of older adults. While traditionally viewed as a peripheral vascular disorder, its impact on outcomes in patients with heart failure (HF) remains poorly defined. Objective: To evaluate the association between concomitant CVI and adverse clinical outcomes, including mortality, HF readmission, and acute kidney injury (AKI), in patients hospitalized for heart failure exacerbation. Methods: We utilized the TriNetX research network, comprising electronic health records of over 100 million patients, to identify adults (≥18 years) diagnosed with HF between January 2015 and May 2025. Two cohorts were constructed: HF patients with CVI and HF patients without CVI. A 1:1 propensity score matching (PSM) was performed based on demographics and comorbidities to balance the groups. Kaplan-Meier survival analyses and Cox proportional hazards models were used to assess one-year outcomes, including all-cause mortality, HF rehospitalizations, and incidence of AKI. Results: A total of 214,783 HF patients with CVI were matched to an equal number of HF patients without CVI. The matched cohort had a mean age of 73.2 ± 12.3 years, was predominantly male (56%), and primarily Caucasian (77%). Compared to matched controls, patients with HF and CVI demonstrated a significantly higher risk of all-cause mortality (HR: 1.05; 95% CI: 1.01–1.08; P<0.001), HF rehospitalization (HR: 1.22; 95% CI: 1.21–1.24; P<0.001), and AKI (HR: 1.13; 95% CI: 1.12–1.14; P<0.001). Conclusion: In this large real-world propensity-matched analysis, the presence of chronic venous insufficiency was associated with increased mortality, rehospitalization, and risk of AKI in patients with heart failure. These findings highlight the clinical significance of CVI as a comorbidity in HF and underscore the need for comprehensive management strategies targeting venous disease in this population.