Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 5, October 2026, pages 425-436

Clinical and Metabolic Factors as Predictors of Thirty-Day Readmission in Patients With Acute Decompensated Heart Failure With Reduced Ejection Fraction and Type 2 Diabetes Mellitus

↓ Figure 1. ROC curve of final predictor model of atrial fibrillation on ECG, HR on discharge and postprandial glucose. ROC: receiver operating characteristic; ECG: electrocardiogram; HR: heart rate.

↓ Figure 2. Forest plot comparing AUCs of discharge HR threshold of 76 bpm on all study subjects, subgroup analysis of HR threshold of 78 bpm on NSR study subjects, and subgroup analyses of HR threshold of 78 bpm on AF study subjects. AUC: area under the receiver operating characteristic (ROC) curve; HR: heart rate; bpm: beats per minute; NSR: normal sinus rhythm; AF: atrial fibrillation; CI: confidence interval; SE: standard error.

↓ Figure 3. ROC curve of subgroup analysis between discharge HR and rehospitalization in diabetic ADHF patients with AF. ROC: receiver operating characteristic; HR: heart rate; ADHF: acute decompensated heart failure; AF: atrial fibrillation.

↓ **Table 1.** Baseline Characteristics of Study Subjects
Variables	Missing data (%)	Total sample (n = 747)
Numerical data with abnormal distribution were presented with median and Min–Max, while numerical data with normal distribution were presented with mean and SD. Categorical data were presented in percentages. SD: standard deviation; bpm: beat per minute; Min: minimum; Max: maximum; ACE-I: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; ARNI: angiotensin receptor neprilysin inhibitor; LOS: length of stay; BUN: blood urea nitrogen; ECG: electrocardiogram; GFR: glomerular filtration rate; SR: sinus rhythm; VT: ventricular tachycardia; AF: atrial fibrillation; MRA: mineralocorticoid receptor antagonist.
Gender	0
Male, n (%)		559 (74.8%)
Female, n (%)		188 (25.2%)
Age (years), median (Min–Max)		58 (31–88)
No. of hospitalizations	0
1–5, n (%)		530 (71%)
6–10, n (%)		135 (18.1)
11–15, n (%)		46 (6.2%)
> 15, n (%)		36 (4.8%)
LOS (days), median (Min–Max)	0	6 (1–76)
Infection during admission	0
Yes, n (%)		490 (65.6%)
No, n (%)		257 (34.4%)
Medication adherence	358 (47.9%)
Good, n (%)		173 (44.5%)
Poor, n (%)		216 (55.5%)
Pleural effusion	0
Yes, n (%)		103 (13.8%)
No, n (%)		644 (86.2%)
Chronic kidney disease	0
Yes, n (%)		147 (19.7%)
No, n (%)		600 (80.3%)
ACE-I/ARB/ARNI on discharge	0
Yes, n (%)		690 (92.4%)
No, n (%)		57 (7.6%)
Intensive diuretic on discharge	0
Yes, n (%)		711 (95.2%)
No, n (%)		36 (4.8%)
MRA on discharge	0
Yes, n (%)		510 (68.3%)
No, n (%)		237 (31.7%)
Other diuretic at discharge	0
Yes, n (%)		68 (9.1%)
No, n (%)		679 (90.9%)
Beta-blocker at discharge	0
Yes, n (%)		615 (82.3%)
No, n (%)		132 (17.7%)
Oral hypoglycemic agents at discharge	0
Yes, n (%)		675 (90.4%)
No, n (%)		72 (9.6%)
ECG during admission	0
SR, n (%)		597 (79.9%)
AF, n (%)		117 (15.7%)
VT, n (%)		9 (1.2%)
Other, n (%)		24 (3.2%)
Ejection fraction (%), median (Min–Max)	14 (1.9%)	23(12–39)
Systolic blood pressure (mm Hg), median (Min–Max)	0	101 (69–187)
Diastolic blood pressure (mm Hg), median (Min–Max)	0	65 (29–115)
Heart rate (bpm), median (Min–Max)	0	77 (50–115)
Body weight (kg), median (Min–Max)	47 (6.3%)	65.5 (36.5–142.85)
Body mass index (kg/m²), median (Min–Max)	44 (5.9%)	24.08 (15.43–48.29)
Fasting blood glucose (mg/dL), median (Min–Max)	14 (1.9%)	107 (34–324)
Postprandial blood glucose (mg/dL), median (Min–Max)	13 (1.7%)	145 (51–409)
Kidney function panel
Urea (mg/dL), median (Min–Max)	8 (1.1%)	65.9 (15.3–231.30)
BUN (mg/dL), median (Min–Max)	11 (1.5%)	31 (7–109)
Creatinine (mg/dL), median (Min–Max max)	11 (1.5%)	1.47 (0.45–9.66)
GFR (mL/min/1.73 m²), median (Min–Max)	14 (1.9%)	46 (4–133)
Hemoglobin (g/dL), mean ± SD	16 (2.1%)	13.05 ± 2.12
Sodium (mmol/L), median (Min–Max)	3 (0.4%)	137 (113–147)
Potassium (mmol/L), median (Min–Max)	3 (0.4%)	4 (2.7–6.0)
Chloride (mmol/L), median (Min–Max)	3 (0.4%)	95 (72–111)
Calcium (mmol/L), median (Min–Max)	174 (23.3%)	2.22 (1.74–2.66)
Magnesium (mmol/L), median (Min–Max)	157 (21.0%)	2.0 (1.2–3.1)

↓ Table 1. Baseline Characteristics of Study Subjects

Variables

Missing data (%)

Total sample (n = 747)

Numerical data with abnormal distribution were presented with median and Min–Max, while numerical data with normal distribution were presented with mean and SD. Categorical data were presented in percentages. SD: standard deviation; bpm: beat per minute; Min: minimum; Max: maximum; ACE-I: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; ARNI: angiotensin receptor neprilysin inhibitor; LOS: length of stay; BUN: blood urea nitrogen; ECG: electrocardiogram; GFR: glomerular filtration rate; SR: sinus rhythm; VT: ventricular tachycardia; AF: atrial fibrillation; MRA: mineralocorticoid receptor antagonist.

Gender

Male, n (%)

559 (74.8%)

Female, n (%)

188 (25.2%)

Age (years), median (Min–Max)

58 (31–88)

No. of hospitalizations

1–5, n (%)

530 (71%)

6–10, n (%)

135 (18.1)

11–15, n (%)

46 (6.2%)

> 15, n (%)

36 (4.8%)

LOS (days), median (Min–Max)

6 (1–76)

Infection during admission

Yes, n (%)

490 (65.6%)

No, n (%)

257 (34.4%)

Medication adherence

358 (47.9%)

Good, n (%)

173 (44.5%)

Poor, n (%)

216 (55.5%)

Pleural effusion

Yes, n (%)

103 (13.8%)

No, n (%)

644 (86.2%)

Chronic kidney disease

Yes, n (%)

147 (19.7%)

No, n (%)

600 (80.3%)

ACE-I/ARB/ARNI on discharge

Yes, n (%)

690 (92.4%)

No, n (%)

57 (7.6%)

Intensive diuretic on discharge

Yes, n (%)

711 (95.2%)

No, n (%)

36 (4.8%)

MRA on discharge

Yes, n (%)

510 (68.3%)

No, n (%)

237 (31.7%)

Other diuretic at discharge

Yes, n (%)

68 (9.1%)

No, n (%)

679 (90.9%)

Beta-blocker at discharge

Yes, n (%)

615 (82.3%)

No, n (%)

132 (17.7%)

Oral hypoglycemic agents at discharge

Yes, n (%)

675 (90.4%)

No, n (%)

72 (9.6%)

ECG during admission

SR, n (%)

597 (79.9%)

AF, n (%)

117 (15.7%)

VT, n (%)

9 (1.2%)

Other, n (%)

24 (3.2%)

Ejection fraction (%), median (Min–Max)

14 (1.9%)

23(12–39)

Systolic blood pressure (mm Hg), median (Min–Max)

101 (69–187)

Diastolic blood pressure (mm Hg), median (Min–Max)

65 (29–115)

Heart rate (bpm), median (Min–Max)

77 (50–115)

Body weight (kg), median (Min–Max)

47 (6.3%)

65.5 (36.5–142.85)

Body mass index (kg/m²), median (Min–Max)

44 (5.9%)

24.08 (15.43–48.29)

Fasting blood glucose (mg/dL), median (Min–Max)

14 (1.9%)

107 (34–324)

Postprandial blood glucose (mg/dL), median (Min–Max)

13 (1.7%)

145 (51–409)

Kidney function panel

Urea (mg/dL), median (Min–Max)

8 (1.1%)

65.9 (15.3–231.30)

BUN (mg/dL), median (Min–Max)

11 (1.5%)

31 (7–109)

Creatinine (mg/dL), median (Min–Max max)

11 (1.5%)

1.47 (0.45–9.66)

GFR (mL/min/1.73 m²), median (Min–Max)

14 (1.9%)

46 (4–133)

Hemoglobin (g/dL), mean ± SD

16 (2.1%)

13.05 ± 2.12

Sodium (mmol/L), median (Min–Max)

3 (0.4%)

137 (113–147)

Potassium (mmol/L), median (Min–Max)

3 (0.4%)

4 (2.7–6.0)

Chloride (mmol/L), median (Min–Max)

3 (0.4%)

95 (72–111)

Calcium (mmol/L), median (Min–Max)

174 (23.3%)

2.22 (1.74–2.66)

Magnesium (mmol/L), median (Min–Max)

157 (21.0%)

2.0 (1.2–3.1)

↓ **Table 2.** Bivariate Analysis of Independent Categorical Variables to the Incidence of Heart Failure Readmission in 30 Days
Variables	Readmission/yes, n (%)	Readmission/no, n (%)	P value	RR	95% CI
ACE-I: angiotensin-converting enzyme inhibitor; AF: atrial fibrillation; ARB: angiotensin receptor blocker; ARNI: angiotensin receptor neprilysin inhibitor; CKD: chronic kidney disease; ECG: electrocardiogram; SR: sinus rhythm; VT: ventricular tachycardia; MRA: mineralocorticoid receptor antagonist; RR: risk ratio; CI: confidence interval; Min: minimum; Max: maximum; OHO: oral hypoglycemic agents
Gender
Male	127 (70.9)	432 (76.1)	0.170	1.217	0.923	1.606
Female	52 (29.1)	136 (23.9)
Infection during admission
Yes	47 (26.3)	125 (22.0)	0.239	1.191	0.894	1.585
No	132 (73.7)	443 (78.0)
Pleural effusion
Yes	21 (11.7)	82 (14.4)	0.360	0.830	0.554	1.245
No	158 (88.3)	486 (85.6)
CKD
Yes	36 (20.1)	111 (19.5)	0.867	1.029	0.895	1.097
No	143 (79.9)	457 (80.5)
Adherence
Good	51 (53.1)	122 (41.6)	0.049	0.706	0.499	1.000
Poor	45 (46.9)	171 (58.4)
ECG during admission
SR	129 (72.1)	468 (82.4)	0.005		—	—
AF	43 (24.0)	74 (13.0)	0.001	2.108	1.380	3.219
VT	3 (1.7)	6 (1.1)	0.404	1.814	0.448	7.353
Other	4 (2.2)	20 (3.5)	0.564	0.726	0.244	2.160
ACE-I/ARB/ARNI on discharge
Yes	158 (88.3)	532 (93.7)	0.018	0.622	0.431	0.897
No	21 (11.7)	36 (6.3)
Intensive diuretic on discharge
Yes	170 (95.0)	541 (95.3)	0.881	0.956	0.535	1.710
No	9 (5.0)	27 (4.7)
Other diuretics on discharge
Yes	14 (7.8)	54 (9.5)	0.494	0.847	0.521	1.376
No	165 (92.2)	514 (90.5)
Beta-blocker on discharge
Yes	140 (78.2)	475 (83.6)	0.098	0.770	0.570	1.041
No	39 (21.8)	93 (16.4)
MRA on discharge
Yes	127 (71.0)	383 (67.4)	0.378	1.135	0.855	1.507
No	52 (29.0)	185 (32.6)
OHO/insulin on discharge
Yes	163 (91.1)	512 (90.1)	0.716	1.087	0.691	1.708
No	16 (8.9)	56 (9.9)
Fasting blood glucose (mg/dL)
≥ 100	121 (70.0)	333 (59.5)	0.013	1.430	1.071	1.909
< 100	52 (30.0)	227 (40.5)
Postprandial glucose (mg/dL)
≥ 140	119 (68.4)	291 (52.0)	0.000	1.710	1.287	2.272
< 140	55 (31.6)	269 (48.0)

↓ Table 2. Bivariate Analysis of Independent Categorical Variables to the Incidence of Heart Failure Readmission in 30 Days

Variables

Readmission/yes, n (%)

Readmission/no, n (%)

P value

95% CI

Min

Max

ACE-I: angiotensin-converting enzyme inhibitor; AF: atrial fibrillation; ARB: angiotensin receptor blocker; ARNI: angiotensin receptor neprilysin inhibitor; CKD: chronic kidney disease; ECG: electrocardiogram; SR: sinus rhythm; VT: ventricular tachycardia; MRA: mineralocorticoid receptor antagonist; RR: risk ratio; CI: confidence interval; Min: minimum; Max: maximum; OHO: oral hypoglycemic agents

Gender

Male

127 (70.9)

432 (76.1)

0.170

1.217

0.923

1.606

Female

52 (29.1)

136 (23.9)

Infection during admission

Yes

47 (26.3)

125 (22.0)

0.239

1.191

0.894

1.585

132 (73.7)

443 (78.0)

Pleural effusion

Yes

21 (11.7)

82 (14.4)

0.360

0.830

0.554

1.245

158 (88.3)

486 (85.6)

CKD

Yes

36 (20.1)

111 (19.5)

0.867

1.029

0.895

1.097

143 (79.9)

457 (80.5)

Adherence

Good

51 (53.1)

122 (41.6)

0.049

0.706

0.499

1.000

Poor

45 (46.9)

171 (58.4)

ECG during admission

129 (72.1)

468 (82.4)

0.005

—

43 (24.0)

74 (13.0)

0.001

2.108

1.380

3.219

3 (1.7)

6 (1.1)

0.404

1.814

0.448

7.353

Other

4 (2.2)

20 (3.5)

0.564

0.726

0.244

2.160

ACE-I/ARB/ARNI on discharge

Yes

158 (88.3)

532 (93.7)

0.018

0.622

0.431

0.897

21 (11.7)

36 (6.3)

Intensive diuretic on discharge

Yes

170 (95.0)

541 (95.3)

0.881

0.956

0.535

1.710

9 (5.0)

27 (4.7)

Other diuretics on discharge

Yes

14 (7.8)

54 (9.5)

0.494

0.847

0.521

1.376

165 (92.2)

514 (90.5)

Beta-blocker on discharge

Yes

140 (78.2)

475 (83.6)

0.098

0.770

0.570

1.041

39 (21.8)

93 (16.4)

MRA on discharge

Yes

127 (71.0)

383 (67.4)

0.378

1.135

0.855

1.507

52 (29.0)

185 (32.6)

OHO/insulin on discharge

Yes

163 (91.1)

512 (90.1)

0.716

1.087

0.691

1.708

16 (8.9)

56 (9.9)

Fasting blood glucose (mg/dL)

≥ 100

121 (70.0)

333 (59.5)

0.013

1.430

1.071

1.909

< 100

52 (30.0)

227 (40.5)

Postprandial glucose (mg/dL)

≥ 140

119 (68.4)

291 (52.0)

0.000

1.710

1.287

2.272

< 140

55 (31.6)

269 (48.0)

↓ **Table 3.** Bivariate Analysis of Independent Numerical Variables on Incidence of Heart Failure (HF) Readmission in 30 Days
Variable	HF readmission (n = 179)	No readmission (n = 568)	P value
BUN: blood urea nitrogen; DBP: diastolic blood pressure; GFR: glomerular filtration rate; HF: heart failure; SBP: systolic blood pressure; BMI: body mass index; SD: standard deviation; bpm: beat per minute; Min: minimum; Max: maximum.
Age (yrs), median (Min–Max)	59 (40–77)	58 (31–88)	0.054
SBP (mm Hg), median (Min–Max)	106 (69–164)	101 (69–187)	0.005
DBP (mm Hg), median (Min–Max)	66 (33–109)	65 (29–115)	0.173
Heart rate (bpm), median (Min–Max)	81 (50–114)	72 (51–105)	0.000
Body weight (kg), median (Min–Max)	65 (38.45–128)	65.8 (36.5–142.85)	0.776
BMI (kg/m²), median (Min–Max)	23.94 (15.82–45.90)	24.16 (15.43–48.29)	0.476
Fasting blood glucose (mg/dL), median (Min–Max)	113 (40–321)	104 (34–324)	0.015
Post–prandial glucose (mg/dL), median (Min–Max)	158.5 (80–372)	142.5 (51–409)	0.002
Urea (mg/dL), median (Min–Max)	72 (19.7–231.3)	62.2 (15.3–207.5)	0.001
BUN (mg/dL), median (Min–Max)	33.5 (9–109)	29 (7–97)	0.001
Creatinine (mg/dL), median (min– max)	1.49 (0.52–8.76)	1.46 (0.45–9.66)	0.760
GFR (mL/min/1.73 m²), median (min–max)	46 (5–112)	46 (4–133)	0.698
Sodium (mmol/L), median (Min–Max)	137 (121–144)	137 (113–147)	0.578
Potassium (mmol/L), median (Min–Max)]	4.0 (2.7–5.5)	4.0 (2.8–6)	0.387
Chloride (mmol/L), median (Min–Max)	95 (78–109)	95 (72–111)	0.260
Calcium (mmol/L), median (Min–Max)	2.22 (1.90–2.54)	2.22 (1.74–2.66)	0.687
Magnesium (mmol/L), median (Min–Max)	2.0 (1.30–2.80)	2.0 (1.20–3.10)	0.144
Ejection fraction (%), median (Min–Max)	22.15 (12.0–38.7)	23.00 (12–39)	0.171
Serum hemoglobin (g/dL), mean ± SD	12.94 ± 2.16	13.08 ± 2.11	0.453

↓ Table 3. Bivariate Analysis of Independent Numerical Variables on Incidence of Heart Failure (HF) Readmission in 30 Days

Variable

HF readmission (n = 179)

No readmission (n = 568)

P value

BUN: blood urea nitrogen; DBP: diastolic blood pressure; GFR: glomerular filtration rate; HF: heart failure; SBP: systolic blood pressure; BMI: body mass index; SD: standard deviation; bpm: beat per minute; Min: minimum; Max: maximum.

Age (yrs), median (Min–Max)

59 (40–77)

58 (31–88)

0.054

SBP (mm Hg), median (Min–Max)

106 (69–164)

101 (69–187)

0.005

DBP (mm Hg), median (Min–Max)

66 (33–109)

65 (29–115)

0.173

Heart rate (bpm), median (Min–Max)

81 (50–114)

72 (51–105)

0.000

Body weight (kg), median (Min–Max)

65 (38.45–128)

65.8 (36.5–142.85)

0.776

BMI (kg/m²), median (Min–Max)

23.94 (15.82–45.90)

24.16 (15.43–48.29)

0.476

Fasting blood glucose (mg/dL), median (Min–Max)

113 (40–321)

104 (34–324)

0.015

Post–prandial glucose (mg/dL), median (Min–Max)

158.5 (80–372)

142.5 (51–409)

0.002

Urea (mg/dL), median (Min–Max)

72 (19.7–231.3)

62.2 (15.3–207.5)

0.001

BUN (mg/dL), median (Min–Max)

33.5 (9–109)

29 (7–97)

0.001

Creatinine (mg/dL), median (min– max)

1.49 (0.52–8.76)

1.46 (0.45–9.66)

0.760

GFR (mL/min/1.73 m²), median (min–max)

46 (5–112)

46 (4–133)

0.698

Sodium (mmol/L), median (Min–Max)

137 (121–144)

137 (113–147)

0.578

Potassium (mmol/L), median (Min–Max)]

4.0 (2.7–5.5)

4.0 (2.8–6)

0.387

Chloride (mmol/L), median (Min–Max)

95 (78–109)

95 (72–111)

0.260

Calcium (mmol/L), median (Min–Max)

2.22 (1.90–2.54)

2.22 (1.74–2.66)

0.687

Magnesium (mmol/L), median (Min–Max)

2.0 (1.30–2.80)

2.0 (1.20–3.10)

0.144

Ejection fraction (%), median (Min–Max)

22.15 (12.0–38.7)

23.00 (12–39)

0.171

Serum hemoglobin (g/dL), mean ± SD

12.94 ± 2.16

13.08 ± 2.11

0.453

↓ **Table 4.** Result of Multivariate Analysis on Factors Associated With Heart Failure Readmission in 30 Days
Variables	P	OR	95% CI
ECG: electrocardiogram; OR: odds ratio; CI: confidence interval.
Atrial fibrillation on ECG	0.000	2.616	1.604	4.267
Heart rate on discharge	0.010	1.022	1.005	1.039
Postprandial glucose < 140 mg/dL	0.003	0.528	0.348	0.802

↓ Table 4. Result of Multivariate Analysis on Factors Associated With Heart Failure Readmission in 30 Days

Variables

95% CI

Minimum

Maximum

ECG: electrocardiogram; OR: odds ratio; CI: confidence interval.

Atrial fibrillation on ECG

0.000

2.616

1.604

4.267

Heart rate on discharge

0.010

1.022

1.005

1.039

Postprandial glucose < 140 mg/dL

0.003

0.528

0.348

0.802