Identification of patients at high risk of death is critical for appropriate management of patients and health care resources. The impact of repeated heart failure (HF) hospitalization on mortality has not been studied for a large community population with HF. We aimed to characterize survival of patients in relation to the number of HF hospitalizations.

Using the health care utilization databases, we identified a cohort of patients with a first hospitalization for HF among all residents of British Columbia between 2000 and 2004. Survival time was measured after patients' first and each subsequent HF hospitalization. Kaplan-Meier cumulative mortality curves were constructed after each subsequent HF hospitalization. Hazard ratios for the number of HF hospitalizations were estimated using a multivariate Cox regression adjusting for major comorbidities.

Of 14374 patients hospitalized for HF, 7401 died during the 24766 person-years of follow-up. Mortality significantly increased after each HF hospitalization. After adjusting for age, sex, and major comorbidities, the number of HF hospitalizations was a strong predictor of all-cause death. Median survival after the first, second, third, and fourth hospitalization was 2.4, 1.4, 1.0, and 0.6 years. Advanced age, renal disease, and history of cardiac arrest attenuated the impact of the number of HF hospitalizations.

The number of HF hospitalizations is a strong predictor of mortality in community HF patients. This simple predictor of mortality in HF patients should help triage management and resources for HF and trigger patient planning for prognosis.