AimsTo study the long-term prognostic value of red blood cell distribution width (RDW) in patients hospitalized with acute heart failure (AHF) and to compare the value of this measurement with haemoglobin levels and anaemia status. Methods and resultsDuring a 2-year period, we studied 628 consecutive patients (aged 71 years [interquartile range, IQR: 61 -77], 68% male) hospitalized with AHF. Demographic, clinical, echocardiographic, and laboratory characteristics were registered at discharge and patients were closely followed-up for 38.1 months [16.5-49.1]. Median RDW was 14.4% [13.5 -15.5] and was higher among decedents (15.0% [13.8-16.1] vs. 14.2 [13.3 -15.3], P , 0.001). After adjustment for other prognostic factors in a multivariable Cox proportional-hazards model, RDW remained a significant predictor (P ¼ 0.004, HR 1.072, 95% CI 1.023 -1.124); whereas, haemoglobin or anaemia status did not add prognostic information. RDW levels above the median were associated with a significantly lower survival rate on long-term follow-up (log rank ,0.001). These levels were predictive of death in anaemic patients (n ¼ 263, P ¼ 0.029) and especially in non-anaemic patients (n ¼ 365) (P , 0.001, HR 1.287, 95% CI 1.147-1.445), even after adjustment in the multivariable model. ConclusionHigher RDW levels at discharge were associated with a worse long-term outcome, regardless of haemoglobin levels and anaemia status.--

Background: Uric acid (UA) may be involved in chronic heart failure (HF) pathogenesis, entailing a worse outcome. The purpose of this study was to examine the role of hyperuricaemia as a prognostic marker after hospital discharge in acute HF patients. Methods: We studied 212 patients consecutively discharged after an episode of acute HF with LVEF b 40%. Blood samples for UA measurement were extracted in the morning prior to discharge. The evaluated endpoints were death and new HF hospitalization. Results: Mean UA levels were 7.4 ± 2.4 mg/dl (range 1.6 to 16 mg/dl), with 127 (60%) of patients being within the range of hyperuricaemia. Hyperuricaemia was associated with a higher risk of death (n = 48) (HR 2.0, 95% CI 1.1-3.9, p = 0.028), new HF readmission (n = 67) (HR 1.8, 95% CI 1.1-3.1, p = 0.023) and the combined event (n = 100) (HR 1.9, 95% CI 1.2-2.9, p = 0.004). At 24 months, cumulative event-free survival was lower in the two higher UA quartiles (36.9% and 40.7% vs. 63.5% and 59.5%, log rank = 0.006). After adjustment for potential confounders, hyperuricaemia remains an independent risk factor for adverse outcomes (HR 1.6, 95% CI 1.1-2.6, p = 0.02). Conclusions: In hospitalized patients with acute HF and LV systolic dysfunction, hyperuricaemia is a long-term prognostic marker for death and/or new HF readmission.

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