PARADISE: gelijktijdig acuut hartfalen plus luchtweginfectie verhoogt sterfte tijdens opname, niet daarna

Background: Acute heart failure (AHF) and respiratory infection (RI) frequently coexist, with the latter commonly regarded as a trigger of AHF decompensation. However, the independent and combined prognostic impact of these conditions on survival is not well studied. We assessed the association of AHF and RI, both separately and in combination, with subsequent mortality. Methods: Patients discharged with diagnoses of AHF, RI, or both were identified from the PARADISE study, a large French cohort of patients hospitalised for acute dyspnoea (2010–2019). Associations with in-hospital and post-discharge mortality were assessed using multivariable binomial logistic regression and Cox proportional hazards models, respectively. Results: Among 11,679 patients, 4,349 (37%) had AHF alone, 5,091 (44%) had RI alone, and 2,239 (19%) had both AHF and RI. In-hospital mortality was highest in patients with concomitant AHF and RI (21.9%), whereas post-discharge mortality was highest among those with AHF (55.2% at 5 years). After multivariable adjustment, AHF+RI together had higher in-hospital mortality than AHF alone (aOR 1.62; 95% CI 1.33–1.98; p<0.001), but not higher post-discharge mortality (aHR 0.99; 95% CI 0.88–1.11; p=0.9). RI alone was not associated with higher mortality, either in-hospital (aOR 1.11; p=0.3) or post-discharge (aHR 1.07; p=0.2). Conclusions: Patients with concomitant AHF and RI face increased in-hospital risk but no excess post-discharge risk compared with AHF alone, whereas RI alone is not associated with increased mortality. Concomitant RI is a marker for in-hospital severity, but long-term prognosis is governed by AHF itself.