Abstract Background Little information is available on non-cardiovascular (CV) death in acute heart failure (AHF) patients. The present study determined the incidence, time course, and factors associated with long-term non-CV death in AHF patients in a real-world setting. Methods The ATTEND registry, a nationwide, prospective observational multicenter cohort study, included 4842 consecutive patients hospitalized for AHF. The primary endpoint of the present study was non-CV death. Results Median follow-up duration from admission was 513 (range, 385–778) days. Over the study period, 1183 patients died; 356 deaths (30.1%) were non-CV related. The proportion of non-CV deaths increased in the later follow-up phase (0–180days, 26.7%; 181–360days, 38.4%; >360days, 36.6%, p <0.001). After adjustment for all variables at baseline, age (hazard ratio [HR] 1.6 per decade, p <0.001) and non-cardiac comorbidities including chronic obstructive pulmonary disease (HR 1.58, p =0.003), history of stroke (HR 1.44, p =0.011), renal insufficiency (HR 1.07, per 10ml/min/1.73m2 decrease in estimated glomerular filtration, p =0.015), and hemoglobin (HR 1.15 per 1.0g/dl decrease, p <0.001) were strongly associated with non-CV death. Other predictors included ischemic etiology (HR 1.33, p =0.023), prior hospitalization for heart failure (HR 1.34, p =0.017), C-reactive protein (HR 1.04, p <0.001), and statin use (HR 0.70, p =0.016). Conclusions The incidence of non-CV death was high in patients with AHF, accounting for 30% of long-term mortality. Furthermore, the proportion of non-CV death increased in the later follow-up phase. Better understanding of non-CV death and more comprehensive treatment of non-CV comorbidities are vital to further improving prognosis in AHF patients.
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