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Despite progress in therapy, heart failure (HF) inflicts a heavy burden of hospital admissions. In this study, we identified among 1360 community-dwelling HF patients (mean age 70.7 ± 11.3 years, 72.5% men) subgroups sharing similar profiles of unplanned hospital admissions, based on the admission causes and frequency of each cause. Hospital discharge summaries were reviewed for the main admission cause. Patient subgroups were identified via cluster analysis. We investigated baseline predictors associated with these subgroups, using multinomial logistic models. During 3421 patient-years, there were 5192 hospital admissions, of which 4252 (82%) were unplanned. We identified five patient subgroups (clusters 1-5) with distinctive hospitalization profiles. HF accounted for approximately one-third of admissions in the first patient cluster (23% of the patient sample). In contrast, patients in the second cluster (39% of the patient sample) were hospitalized for various reasons, with no single prominent admission cause identified. The other three clusters, comprising 16% of the patient sample, accounted for 42% of all unplanned hospitalizations. While patients in the third cluster were hospitalized mainly due to ischemic heart disease and arrhythmia, patients in the fourth and fifth clusters shared a high burden of recurrent HF admissions. The five patient clusters differed by baseline predictors, including age, functional capacity, comorbidity burden, hemoglobin, and cause of HF. HF patients differ significantly in the causes and overall burden of unplanned hospitalizations. The patient subgroups identified and predictors for these subgroups may guide personalized interventions to reduce the burden of unplanned hospitalizations among HF patients. Trial registration: ClinicalTrials.gov, NCT00533013. Registered 20 September 2007. https://clinicaltrials.gov/study/NCT00533013 ., (© 2024. The Author(s).)

Background: Heart failure with improved ejection fraction (HFimpEF) is a recently recognized entity presenting a diagnostic and therapeutic challenge. Our aim was to characterize the profile of HFimpEF patients and evaluate predictors for EF lack of improvement among heart failure with reduced ejection fraction (HFrEF) patients., Methods: We included ambulatory HFrEF patients (EF≤40%) between January 1, 2015, and September 1, 2022, with two consecutive echocardiography exams at least 6 months apart. HFimpEF was defined as improved EF from ≤40%->40% and by ≥10%., Results: A total of 567 HFrEF patients (72% male, 54.3 ± 14.4 years old) were analyzed. Patients without EF improvement were more likely to be male, had more comorbidities, ischemic cardiomyopathy (ICMP), markers of adverse cardiac remodeling (lower EF and higher left and right ventricular diameters) and presence of late gadolinium enhancement (LGE) in MRI ( P  < 0.05 for all). In a multivariate analysis, male sex, ICMP, lower EF, larger ventricular size and LGE remained independent predictors for lack of EF improvement. A prediction model for lack of EF improvement including LVEF, LV diameter, diastolic blood pressure and ischemic etiology exhibited an area under the ROC curve of 0.77 (95% CI 0.73-0.81; P  < 0.001). HFimpEF patients had better prognosis with lower hospitalizations and mortality rates. Guideline directed medical therapy (GDMT) were associated with improved outcomes in both groups regardless of EF improvement., Conclusions: Lack of improvement in EF among HFrEF patients may be predicted by HF etiology and imaging parameters of adverse cardiac remodeling, and is associated with worse prognosis. GDMT were associated with improved outcomes in both HFimpEF and HFrEF patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Segev, Avrahamy, Fardman, Matetzky, Freimark, Regev, Kuperstein and Grupper.)

Recurrent pericarditis (RP) complicates approximately 30% of acute pericarditis (AP) cases. We sought to compare the prevalence and severity of objective findings seen in patients with RP. A retrospective single-center study during 2010-2019, including 765 patients diagnosed with AP. Clinical, electrocardiographic, echocardiographic, and laboratory findings were extracted from the local electronic health records. Recurrence during follow-up was documented in 134 patients (17.5%), with a median time to recurrence of 101 (± 59-251) days. The median age was 60 years (IQR 45-72), 68% were male. Most patients were defined as having idiopathic\viral pericarditis (64%). The clinical manifestation during the recurrent event of pericarditis was less prominent or attenuated when compared to the initial event-ECG signs (ST elevation 12% vs. 26%; p = 0.006, Knuckle sign 13% vs. 33%; p < 0.001, ST larger in lead L2 than L3 4% vs. 19%; p < 0.001), pericardial effusion moderate and above (11% vs. 30%; p = 0.02), and inflammatory markers (mean peak CRP levels 66 mg/l vs. 97 mg/l; p < 0.001). Similar results were seen in the subgroup of patients defined as having idiopathic\viral pericarditis. Up to 20% of patients who did not have ECG signs or a significant pericardial effusion in their 1st event demonstrated these findings during the recurrence, though still to a lesser extent compared with those who had these signs in their 1st event. The objective findings of AP are less pronounced during recurrent events. Future studies should focus on the role of advanced biomarkers and imaging in defining true RP events., (© 2024. The Author(s).)