Prognostic performance of the BAN-ADHF score in acute decompensated heart failure: a sub-analysis of the Spanish Heart Failure Registry (RICA).

The BAN-ADHF score is a recently developed measure designed to predict low diuretic efficiency and adverse outcomes using eight simple routinely available clinical and laboratory variables. However, its performance in real-world settings remains understudied. This is a retrospective analysis using data from the Spanish Heart Failure Registry (RICA), a nationwide, prospective cohort of patients admitted for ADHF to internal medicine departments. Only patients with complete data to calculate the BAN-ADHF score were included. Patients were classified into low BAN-ADHF (< 12) and high BAN-ADHF (≥ 12) groups. The primary endpoint was all-cause mortality. Secondary endpoints included the composite of mortality and/or heart failure (HF) readmission and length of hospital stay. A total of 2110 were eligible. High BAN-ADHF patients (17.5%) were older, with a higher burden of comorbidities, worse functional class and a higher proportion of reduced left ventricular ejection fraction (LVEF). Additionally, high BAN-ADHF patients showed lower hemoglobin, sodium, and estimated glomerular filtration rate, together with higher levels of creatinine, potassium, CA125, and NT-proBNP. After a median follow-up of 363 days, all-cause mortality occurred in 30.3% of patients, predominantly in the high BAN-ADHF group (HR 1.75, 95% CI 1.46-2.08, p = 0.001). The composite endpoint occurred in 44.9% of patients and was more frequent in the high BAN-ADHF group (HR 1.47, 95% CI 1.24-1.76, p = 0.001). Moreover, the BAN-ADHF score was independently associated with longer hospital stays (p = 0.001). No interaction was found between LVEF and the BAN-ADHF categories. The BAN-ADHF score is a valuable prognostic tool for identifying ADHF patients at greater risk of mortality, rehospitalization, and longer hospitalization in a real-world setting. Its integration into routine care may help guide early therapeutic strategies and resource allocation.