The Significance of Red Blood Cell Distribution Width (RDW) in Predicting Early Readmission of Acute Heart Failure
-
Mohammad Javad Alborzi
,
Nasim Naderi
,
Mohammad Reza Baay
,
Sepideh Taghavi
,
Razieh Omidvar
,
Marzieh Mirtajaddini
,
Hooman Bakhshandeh
Abstract
Background: Hospitalizations for acute decompensated heart failure (ADHF) impose a substantial health care burden, and prognosis worsens with each readmission. Identifying patients at risk of frequent hospitalization is therefore essential. Red blood cell distribution width (RDW) has recently gained attention as a prognostic biomarker in cardiovascular disease. This study evaluated the prognostic value of baseline RDW and its in-hospital changes in patients admitted with ADHF.
Methods: In this retrospective observational cohort study, all adults hospitalized with ADHF between March 2022 and August 2024 were assessed. Demographic, clinical, echocardiographic, and laboratory data–including admission RDW and in-hospital RDW measurements–were extracted from the hospital information system and medical records. Early readmission for HF within 30 days after discharge was defined as the primary end point, and in-hospital mortality as the secondary end point.
Results: Among 1871 hospitalization records from 1409 patients (66.9% male; mean [SD] age, 59.3 [12.4] years), 984 cases with available follow-up data were analyzed. The mean length of stay (LOS) was 9.5 days, and the mean New York Heart Association (NYHA) class was 3.3. Early readmission occurred in 201 records (20.4% of admissions, 22% of patients). Baseline RDW independently predicted both outcomes: each 1-unit increase in RDW was associated with an 11% higher risk of early readmission and a 16% higher risk of in-hospital mortality. Additionally, a 1-unit increase in the change in RDW from admission to last measurement (ΔRDW) and the ratio of ΔRDW to LOS (ΔRDW/LOS) was linked to a 1.3-fold and 2.3-fold higher mortality risk, respectively.
Conclusion: Baseline RDW on admission is a strong, independent predictor of both early readmission and in-hospital mortality in patients with ADHF. RDW may serve as a simple and cost-effective marker for risk stratification and early intervention in this population.
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2. Park C, Otobo E, Ullman J, Rogers J, Fasihuddin F, Garg S, et al. Impact on readmission reduction among heart failure patients using digital health monitoring: feasibility and adoptability study. JMIR Med Inform. 2019;7(4):1-10.
3. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726.
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7. Lee DS, Stitt A, Austin PC, Stukel TA, Schull MJ, Chong A, et al. Prediction of heart failure mortality in emergent care: a cohort study. Ann Intern Med. 2012;156(11):767-75.
8. O'Connor CM, Mentz RJ, Cotter G, Metra M, Cleland JG, Davison BA, et al. The PROTECT in-hospital risk model: 7-day outcome in patients hospitalized with acute heart failure and renal dysfunction. Eur J Heart Fail. 2012;14(6):605-12.
9. Palazzuoli A, Evangelista I, Ruocco G, Lombardi C, Giovannini V, Nuti R, et al. Early readmission for heart failure: an avoidable or ineluctable debacle? Int J Cardiol. 2019;277:186-95.
10. Prudhomme P, et al. Abstract 15017: early post-discharge follow-up delay after hospitalization for heart failure with preserved ejection fraction reduces readmission for heart failure in the following year. Circulation. 2020;142(Suppl_3):A15017.
11. Hallerbach M, Francoeur A, Pomerantz SC, Oliner C, Morris DL, Eiger G, et al. Patterns and predictors of early hospital readmission in patients with congestive heart failure. Am J Med Qual. 2008;23(1):18-23.
12. Fudim M, O'Connor CM, Dunning A, Ambrosy AP, Armstrong PW, Coles A, et al. Aetiology, timing and clinical predictors of early vs. late readmission following index hospitalization for acute heart failure: insights from ASCEND-HF. Eur J Heart Fail. 2018;20(2):304-14.
13. Naderi N, Chenaghlou M, Mirtajaddini M, Norouzi Z, Mohammadi N, Amin A, et al. Predictors of readmission in hospitalized heart failure patients. J Cardiovasc Thorac Res. 2022;14(1):11-7.
14. Hullin R, Barras N, Abdurashidova T, Monney P, Regamey J. Red cell distribution width and prognosis in acute heart failure: ready for prime time! Intern Emerg Med. 2019;14(2):195-7.
15. Su JL, Zhang SG, Gao RJ, Han QF, Wang LH, Zhou YH, et al. Red cell distribution width is a predictor of mortality in patients with chronic heart failure. Int J Cardiol. 2016;212:79-81.
16. Zhang X, Wang Y, Chen N, Liu Y, Xiao J, Lin Z, et al. Red cell distribution width is associated with short-term mortality in critically ill patients with heart failure. ESC Heart Fail. 2022;9(5):3210-20.
17. Melchio R, Rinaldi G, Testa E, Giraudo A, Serraino C, Bracco C, et al. Red cell distribution width predicts mid-term prognosis in patients hospitalized with acute heart failure: the RDW in acute heart failure (RE-AHF) study. Intern Emerg Med. 2019;14(2):239-47.
18. Sotiropoulos K, Yerly P, Monney P, Garnier A, Regamey J, Hugli O, et al. Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction. ESC Heart Fail. 2016;3(3):198-204.
19. Muhlestein JB, Lappe DL, Anderson JL, Muhlestein JB, Budge D, May HT, et al. Both initial red cell distribution width (RDW) and change in RDW during heart failure hospitalization are associated with length of hospital stay and 30-day outcomes. Int J Lab Hematol. 2016;38(3):328-37.
20. Dai Y, Konishi H, Takagi A, Miyauchi K, Daida H. Red cell distribution width predicts short- and long-term outcomes of acute congestive heart failure more effectively than hemoglobin. Exp Ther Med. 2014;8(2):600-6.
21. Xanthopoulos A, Giamouzis G, Dimos A, Skoularigki E, Starling RC, Skoularigis J, et al. Red blood cell distribution width in heart failure: pathophysiology, prognostic role, controversies and dilemmas. J Clin Med. 2022;11(7).
22. Uemura Y, Shibata R, Takemoto K, Uchikawa T, Koyasu M, Watanabe H, et al. Elevation of red blood cell distribution width during hospitalization predicts mortality in patients with acute decompensated heart failure. J Cardiol. 2016;67(3):268-73.
23. Ji X, Ke W. Red blood cell distribution width and all-cause mortality in congestive heart failure patients: a retrospective cohort study based on the Mimic-III database. Front Cardiovasc Med. 2023;10(May).
24. Förhécz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohászka Z, Jánoskuti L. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009;158(4):659-66.
25. Garcia-Gutierrez S, Villanueva A, Lafuente I, Rodriguez I, Lozano-Bahamonde A, Murga N, et al. Factors related to early readmissions after acute heart failure: a nested case–control study. BMC Cardiovasc Disord. 2023;23(1):1-10.
26. Xexemeku F, Singh A, Adjepong YA, Zarich S. Predictors of early readmission in heart failure patients in an inner-city community hospital. World J Cardiovasc Dis. 2014;4(9):476-82.
27. O'Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365(1):32-43.
28. Konstam MA, Gheorghiade M, Burnett JC Jr, Grinfeld L, Maggioni AP, Swedberg K, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA. 2007;297(12):1319-31.
29. Packer M, O'Connor C, McMurray JJV, Wittes J, Abraham WT, Anker SD, et al. Effect of ularitide on cardiovascular mortality in acute heart failure. N Engl J Med. 2017;376(20):1956-64.
30. Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003;290(19):2581-7.
31. Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27(22):2725-36.
32. Sato N, Gheorghiade M, Kajimoto K, Munakata R, Minami Y, Mizuno M, et al. Hyponatremia and in-hospital mortality in patients admitted for heart failure (from the ATTEND registry). Am J Cardiol. 2013;111(7):1019-25.
33. Panduranga P, Al-Zakwani I, Sulaiman K, Al-Habib K, Alsheikh-Ali A, Al-Suwaidi J, et al. Comparison of Indian subcontinent and Middle East acute heart failure patients: results from the Gulf Acute Heart Failure Registry. Indian Heart J. 2016;68:S36-44.
2. Park C, Otobo E, Ullman J, Rogers J, Fasihuddin F, Garg S, et al. Impact on readmission reduction among heart failure patients using digital health monitoring: feasibility and adoptability study. JMIR Med Inform. 2019;7(4):1-10.
3. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726.
4. Abraham WT, Fonarow GC, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, et al. Predictors of in-hospital mortality in patients hospitalized for heart failure. Insights from the organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF). J Am Coll Cardiol. 2008;52(5):347-56.
5. Felker GM, Leimberger JD, Califf RM, Cuffe MS, Massie BM, Adams KF Jr, et al. Risk stratification after hospitalization for decompensated heart failure. J Card Fail. 2004;10(6):460-6.
6. Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ. ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005 Feb 2;293(5):572-80.
7. Lee DS, Stitt A, Austin PC, Stukel TA, Schull MJ, Chong A, et al. Prediction of heart failure mortality in emergent care: a cohort study. Ann Intern Med. 2012;156(11):767-75.
8. O'Connor CM, Mentz RJ, Cotter G, Metra M, Cleland JG, Davison BA, et al. The PROTECT in-hospital risk model: 7-day outcome in patients hospitalized with acute heart failure and renal dysfunction. Eur J Heart Fail. 2012;14(6):605-12.
9. Palazzuoli A, Evangelista I, Ruocco G, Lombardi C, Giovannini V, Nuti R, et al. Early readmission for heart failure: an avoidable or ineluctable debacle? Int J Cardiol. 2019;277:186-95.
10. Prudhomme P, et al. Abstract 15017: early post-discharge follow-up delay after hospitalization for heart failure with preserved ejection fraction reduces readmission for heart failure in the following year. Circulation. 2020;142(Suppl_3):A15017.
11. Hallerbach M, Francoeur A, Pomerantz SC, Oliner C, Morris DL, Eiger G, et al. Patterns and predictors of early hospital readmission in patients with congestive heart failure. Am J Med Qual. 2008;23(1):18-23.
12. Fudim M, O'Connor CM, Dunning A, Ambrosy AP, Armstrong PW, Coles A, et al. Aetiology, timing and clinical predictors of early vs. late readmission following index hospitalization for acute heart failure: insights from ASCEND-HF. Eur J Heart Fail. 2018;20(2):304-14.
13. Naderi N, Chenaghlou M, Mirtajaddini M, Norouzi Z, Mohammadi N, Amin A, et al. Predictors of readmission in hospitalized heart failure patients. J Cardiovasc Thorac Res. 2022;14(1):11-7.
14. Hullin R, Barras N, Abdurashidova T, Monney P, Regamey J. Red cell distribution width and prognosis in acute heart failure: ready for prime time! Intern Emerg Med. 2019;14(2):195-7.
15. Su JL, Zhang SG, Gao RJ, Han QF, Wang LH, Zhou YH, et al. Red cell distribution width is a predictor of mortality in patients with chronic heart failure. Int J Cardiol. 2016;212:79-81.
16. Zhang X, Wang Y, Chen N, Liu Y, Xiao J, Lin Z, et al. Red cell distribution width is associated with short-term mortality in critically ill patients with heart failure. ESC Heart Fail. 2022;9(5):3210-20.
17. Melchio R, Rinaldi G, Testa E, Giraudo A, Serraino C, Bracco C, et al. Red cell distribution width predicts mid-term prognosis in patients hospitalized with acute heart failure: the RDW in acute heart failure (RE-AHF) study. Intern Emerg Med. 2019;14(2):239-47.
18. Sotiropoulos K, Yerly P, Monney P, Garnier A, Regamey J, Hugli O, et al. Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction. ESC Heart Fail. 2016;3(3):198-204.
19. Muhlestein JB, Lappe DL, Anderson JL, Muhlestein JB, Budge D, May HT, et al. Both initial red cell distribution width (RDW) and change in RDW during heart failure hospitalization are associated with length of hospital stay and 30-day outcomes. Int J Lab Hematol. 2016;38(3):328-37.
20. Dai Y, Konishi H, Takagi A, Miyauchi K, Daida H. Red cell distribution width predicts short- and long-term outcomes of acute congestive heart failure more effectively than hemoglobin. Exp Ther Med. 2014;8(2):600-6.
21. Xanthopoulos A, Giamouzis G, Dimos A, Skoularigki E, Starling RC, Skoularigis J, et al. Red blood cell distribution width in heart failure: pathophysiology, prognostic role, controversies and dilemmas. J Clin Med. 2022;11(7).
22. Uemura Y, Shibata R, Takemoto K, Uchikawa T, Koyasu M, Watanabe H, et al. Elevation of red blood cell distribution width during hospitalization predicts mortality in patients with acute decompensated heart failure. J Cardiol. 2016;67(3):268-73.
23. Ji X, Ke W. Red blood cell distribution width and all-cause mortality in congestive heart failure patients: a retrospective cohort study based on the Mimic-III database. Front Cardiovasc Med. 2023;10(May).
24. Förhécz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohászka Z, Jánoskuti L. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009;158(4):659-66.
25. Garcia-Gutierrez S, Villanueva A, Lafuente I, Rodriguez I, Lozano-Bahamonde A, Murga N, et al. Factors related to early readmissions after acute heart failure: a nested case–control study. BMC Cardiovasc Disord. 2023;23(1):1-10.
26. Xexemeku F, Singh A, Adjepong YA, Zarich S. Predictors of early readmission in heart failure patients in an inner-city community hospital. World J Cardiovasc Dis. 2014;4(9):476-82.
27. O'Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365(1):32-43.
28. Konstam MA, Gheorghiade M, Burnett JC Jr, Grinfeld L, Maggioni AP, Swedberg K, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA. 2007;297(12):1319-31.
29. Packer M, O'Connor C, McMurray JJV, Wittes J, Abraham WT, Anker SD, et al. Effect of ularitide on cardiovascular mortality in acute heart failure. N Engl J Med. 2017;376(20):1956-64.
30. Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA. 2003;290(19):2581-7.
31. Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27(22):2725-36.
32. Sato N, Gheorghiade M, Kajimoto K, Munakata R, Minami Y, Mizuno M, et al. Hyponatremia and in-hospital mortality in patients admitted for heart failure (from the ATTEND registry). Am J Cardiol. 2013;111(7):1019-25.
33. Panduranga P, Al-Zakwani I, Sulaiman K, Al-Habib K, Alsheikh-Ali A, Al-Suwaidi J, et al. Comparison of Indian subcontinent and Middle East acute heart failure patients: results from the Gulf Acute Heart Failure Registry. Indian Heart J. 2016;68:S36-44.
| Files | ||
| Issue | Vol 21 No 3 (2026) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/rhythm.v21i3.22563 | |
| Keywords | ||
| Red Blood Cell Distribution Width (RDW) Acute Heart Failure Early Readmission In-Hospital Mortality Risk Stratification | ||
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How to Cite
1.
Alborzi MJ, Naderi N, Baay MR, Taghavi S, Omidvar R, Mirtajaddini M, Bakhshandeh H. The Significance of Red Blood Cell Distribution Width (RDW) in Predicting Early Readmission of Acute Heart Failure. Res Heart Yield Transl Med. 2026;21(3):203-213.
