A prognostic nomogram for all-cause mortality in acute decompensated heart failure: a retrospective cohort study

Acute decompensated heart failure (ADHF) is associated with high morbidity and poor prognosis. Although risk scores exist for chronic heart failure, simple tools to predict all-cause mortality in ADHF using readily available clinical factors are still needed. This study aimed to develop and internally validate a nomogram integrating routine clinical and functional parameters for this purpose. In this single-center retrospective cohort study, 108 patients hospitalized with ADHF between October 2020 and October 2022 were enrolled. Comprehensive demographic, biochemical, clinical, and functional assessment data were collected. Functional status was quantified by the Berg Balance Scale, Short Physical Performance Battery, Barthel Index, and a derived Composite Frailty Index (CFI). Univariate and multivariate logistic regression analyses identified independent predictors of all-cause mortality. A nomogram was constructed and its performance evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and the Hosmer–Lemeshow test. Internal validation was performed using 1000 bootstrap resamples. During a median follow-up of 462 days, 55 patients (50.9%) died. Multivariate analysis showed that advanced age (odds ratio [OR] = 1.068, 95% CI 1.011–1.137) and higher CFI (OR = 2.837, 95% CI 0.345–24.248) were associated with increased all-cause mortality, while higher eGFR (OR = 0.985, 95% CI 0.963–1.007), use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor–neprilysin inhibitors (OR = 0.352, 95% CI 0.136–0.874), and participation in cardiac rehabilitation (OR = 0.178, 95% CI 0.039–0.669) were associated with lower mortality. The nomogram incorporating these five variables showed good discrimination (AUC = 0.767, bootstrap-corrected AUC = 0.731) and excellent calibration. Patients were stratified into three risk groups ( n = 36 each) based on nomogram points. Kaplan–Meier analysis revealed median survival times of 576.5, 435.0, and 259.0 days for low-, medium-, and high-risk groups, respectively (log-rank P < 0.001). Compared to the low-risk group, medium- and high-risk groups had a 3.71-fold and 5.94-fold higher mortality risk, respectively. We developed and internally validated a simple prognostic nomogram for ADHF using age, guideline-directed medication use, and cardiac rehabilitation participation. This tool can aid in risk stratification and guide personalized management to improve outcomes. Trial registration : The study protocol was approved by the Hospital Ethics Committee (Approval No: LL(H)-08–04).