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PLOS One | https://doi.org/10.1371/journal.pone.0329829 August 6, 2025 1 / 11 OPEN ACCESSCitation: Marcus G, Monayer A, Moravsky G, Fuchs S, Grupper A, Kalmanovich E, et al. (2025) Limited predictive value of traditional comorbidities for readmission in acute decompensated heart failure. PLoS One 20(8): e0329829. https://doi.org/10.1371/journal.pone.0329829Editor: Pasquale Abete, Universita degli Studi di Napoli Federico II, ITALYReceived: June 10, 2025Accepted: July 22, 2025Published: August 6, 2025Copyright: © 2025 Marcus et al . This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Data availability statement: Due to ethical and legal restrictions imposed by the Institutional Review Board (IRB) of Shamir Medical Center, the dataset used in this study—which contains detailed clinical information from electronic medical records—cannot be publicly shared, RESEARCH ARTICLELimited predictive value of traditional comorbidities for readmission in acute decompensated heart failureGil Marcus1,2 *, Antoinette Monayer 1,2 , Gil Moravsky 1,2 , Shmuel Fuchs 1,2 , Avishay Grupper 1,2 , Eran Kalmanovich 1,2 , Sa’ar Minha 1,21 Department of Cardiology, Shamir Medical Center, Be’er Ya’akov, Israel, 2 Gray Faculty of Medical & Health Sciences, Tel-Aviv University, Tel-Aviv, Israel * gilm@shamir.gov.ilAbstract BackgroundCommon comorbidities in heart failure (HF), including chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD), and atrial fibrillation, are frequently presumed to predict hospital readmission. However, recent studies have challenged their predictive strength, raising questions about their clinical utility for risk stratification.MethodsWe conducted a retrospective cohort study of 7,652 patients admitted with acute decompensated heart failure (ADHF) at a tertiary center between 2007 and 2017. Associations between comorbidities and readmission at 30 and 100 days were assessed using Fine-Gray competing risk models, with death as a competing event. Subdistribution hazard ratios (sHRs) were reported. Model performance was evalu-ated using receiver operating characteristic (ROC) analysis and area under the curve (AUC) values, assessing individual comorbidities and incremental combinations. All comorbidities were included irrespective of univariable significance, based on clinical relevance.ResultsSeveral comorbidities were significantly associated with readmission, including CKD (sHR 1.16–1.23), DM (sHR 1.18–1.27), IHD (sHR 1.10–1.15), and anemia (sHR 1.11). However, predictive power was poor. For 30-day readmission, AUC values ranged from 0.516 (COPD) to 0.529 (CKD), with a maximal AUC of 0.555 when com-bining the four strongest predictors. For 100-day readmission, AUC values ranged from 0.528 (DM) to 0.545 (CKD), with a maximal combined AUC of 0.593.