Background: Patients hospitalized for heart failure (HF) exacerbation tend to have a poor prognosis. Most previous studies were performed in large clinical centers and detailed analyses of patients with HF hospitalized in district general hospitals are lacking.

Aims: The aim of this study was to assess the outcomes of patients admitted with HF exacerbation to a district general hospital.

Methods: We retrospectively enrolled patients hospitalized for HF exacerbation in the years 2010 to 2011 (191 patients) and 2016 to 2017 (203 patients). The primary and secondary endpoints were all‑cause mortality and rehospitalization due to HF exacerbation, respectively, within a 2‑year follow‑up.

Results: Compared with patients hospitalized from 2010 to 2011, those hospitalized from 2016 to 2017 had more favorable clinical parameters and more appropriate pharmacological treatment; however, the rate of implantable cardioverter‑defibrillator and resynchronization device use remained low. The overall mortality decreased from 44% between 2010 and 2011 to 33% between 2016 and 2017 (P = 0.03), but the number of rehospitalizations increased from 26% to 41%, respectively (P < 0.001). Male sex, low systolic blood pressure, symptoms of right HF, and renal dysfunction were independent risk factors for the primary endpoint. Symptoms of right HF, renal dysfunction, left ventricular ejection fraction below 24%, and low systolic blood pressure independently predicted the secondary endpoint.

Conclusions: The prognosis of patients hospitalized for decompensated HF in a regional district hospital was poor. Despite some improvement in pharmacological treatment, which probably led to reduced all‑‑cause mortality, there was a low rate of implantable electronic device use and a high rate of rehospitalizations due to HF exacerbation, which needs further elucidation.