The Significance of Red Blood Cell Distribution Width (RDW) in Predicting Early Readmission of Acute Heart Failure

Authors

  • Mohammad Javad Alborzi Cardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, Iran.
  • Nasim Naderi Cardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, Iran.
  • Mohammad Reza Baay Interventional Cardiology Research Center, Rajaie Cardiovascular Institute, Tehran, Iran.
  • Sepideh Taghavi Heart Valve Disease Research Center, Rajaie Cardiovascular Institute, Tehran, Iran.
  • Razieh Omidvar Cardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, Iran.
  • Marzieh Mirtajaddini Cardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, Iran.
  • Hooman Bakhshandeh Cardiovascular Epidemiology Research Center, Rajaie Cardiovascular Institute, Tehran, Iran.

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

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.

Published

2026-09-08

Issue

Volume (21) issue (3)

Section

Articles