Use of cardiac magnetic resonance imaging after hospitalization for acute heart failure: insights from the French nationwide OFICA-2 cohort.

AIMS: Cardiac magnetic resonance (CMR) has a central role in the management of patients with acute heart failure (AHF), but timely access remains heterogeneous. We investigated real-world CMR use in patients hospitalized for AHF and its associations with demographic, clinical, and institutional characteristics. METHODS AND RESULTS: In the nationwide prospective OFICA2 cohort, conducted from March to April 2021 across 80 centres, we included 906 patients hospitalized for AHF, discharged alive, and without contraindications to CMR (mean age 74.7 years, 42.1% women). CMR use was identified through national billing codes during hospitalization and within 1 year using linked national administrative data. Analyses assessed CMR use across patient subgroups, hospital types, and care settings. Overall, 116 patients (12.8%) underwent CMR during hospitalization or within 1 year. CMR use was more frequent in younger patients, those without myocardial infarction, those with reduced LVEF, and patients with dilated rather than hypertensive or valvular cardiomyopathy. Among patients hospitalized for a first AHF episode, male sex was also associated with higher referral rates. CMR use varied across hospital types and care settings, with higher rates in university hospitals and intensive care units. Among patients with potential CMR indications according to the 2016 ESC Heart Failure guidelines, only 10.9% (class I) and 15.0% (class II) underwent the examination. CONCLUSION: In this nationwide AHF cohort, real-world use of CMR remained limited, even among patients with potential guideline-based indications, with marked patient- and institution-level disparities. These findings support coordinated efforts to improve timely access to CMR in heart failure care.