Background Right heart failure (RHF) is a complex syndrome commonly associated with serious cardiac and/or pulmonary disease and carries a high burden of morbidity and mortality. The burden of RHF versus left heart failure (LHF) and biventricular heart failure is not well-quantified and there is a lack of a direct comparison between these types of heart failure in patients’ data from a large clinical database. This study examines the prevalence of all-cause mortality and common comorbidities such as end-stage renal disease (ESRD) and cirrhosis in patients diagnosed with RHF versus LHF and other HF diagnoses.

Methods Using the Epic COSMOS database, which integrates ICD-10 health information across over 200 health systems in the United States, we evaluated the proportion of death, cirrhosis, ESRD, and average length of hospitalization associated with RHF diagnoses versus other HF diagnoses, including LHF, from 1/1/2010-12/31/2023.

Results From 577392 patients diagnosed with either RHF or LHF, we found 294233 diagnosed with RHF and 302222 diagnosed with LHF. 7027 were diagnosed with both. RHF was associated with an average 38.7±0.2% death compared to 26.6±0.03% (p<0.0001) for that of other HF diagnoses and 31.1±0.2% (p<0.0001) for that of LHF diagnoses. The mean length of hospital stay was 7.5±0.03 days for RHF versus 6.7±0.01 days for other HF diagnoses. Furthermore, RHF patients were more likely to develop cirrhosis (p<0.0001) and ESRD (p<0.0001) than LHF patients after diagnosis.

Conclusion Mortality associated with RHF is 12.3% greater than that of other HF diagnoses and 7.6% greater than that of LHF diagnoses. RHF seems to associate more with serious comorbidities such as ESRD and cirrhosis. Despite the increased mortality and morbidities associated with RHF, the length of hospitalization was not clinically different between the two groups. Since our data shows that RHF indicates a poor prognosis, greater emphasis should be placed on early diagnosis and management of RHF. Further studies are required to explore the pathophysiology of RHF and improve therapeutic approaches.