{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:46:23Z","timestamp":1785735983205,"version":"3.56.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To determine whether admission body roundness index (BRI), a validated anthropometric metric of central adiposity, independently predicts 3-month all-cause readmission and rehospitalization for acute heart failure (AHF) in elderly patients hospitalized for a first AHF episode.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center retrospective cohort study, 317 patients aged &amp;gt;60\u202fyears with a first AHF hospitalization were enrolled and stratified by BRI tertiles. The endpoints were all-cause readmission and AHF rehospitalization within 3\u202fmonths. Patients who died during follow-up were retained in the cohort and censored at the time of death, and associations were analyzed using the cause-specific Cox proportional hazards model. Associations were assessed using multivariable Cox regression, restricted cubic spline analysis, and pre-specified subgroup analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During follow-up, 3 patients (0.95%) died (1 in each tertile at 9, 22, and 45\u202fdays) and were censored at the time of death, and 128 patients (40.76%) experienced all-cause readmission and 68 (21.73%) were rehospitalized for AHF. After full adjustment, each 1-unit increment in BRI was associated with a 48% higher risk of all-cause readmission (HR 1.48, 95% CI 1.20\u20131.83) and a 2.15-fold risk of AHF rehospitalization (HR 2.15, 95% CI 1.55\u20132.98); risks in the highest tertile significantly exceeded those in the lowest tertile. Restricted cubic spline analysis unmasked striking nonlinear threshold effects: all-cause readmission risk escalated sharply when BRI surpassed 5.40 (HR 2.75, 95% CI 1.98\u20133.82), whereas AHF rehospitalization risk surged beyond a BRI of 7.05 (HR 2.93, 95% CI 1.34\u20136.40). Notably, the middle BRI tertile exhibited a markedly lower all-cause readmission risk relative to the lowest tertile (HR 0.38, 95% CI 0.17\u20130.87), whereas AHF rehospitalization risk did not differ. This divergent pattern mechanistically reconciles the \u201cobesity paradox\u201d by distinguishing a sarcopenic phenotype in the lowest-BRI group from a high-adiposity phenotype in the upper extreme. The direction of association remained consistent across all subgroups, with significant effect modification by smoking status, marital status, NYHA class, and diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Admission BRI is an independent predictor of 3-month all-cause readmission and AHF rehospitalization in elderly patients with AHF, and may serve as a simple, low-cost tool for early post-discharge risk stratification in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1897382","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:31:51Z","timestamp":1785735111000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Body roundness index as a predictor of 3-month readmission in elderly patients with first-episode acute heart failure"],"prefix":"10.3389","volume":"13","author":[{"given":"Junfang","family":"Ma","sequence":"first","affiliation":[{"name":"Intensive Care Unit, Shaoxing Second Hospital","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meixiang","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Shaoxing Second Hospital","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fenjuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Shaoxing Second Hospital","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Shaoxing Second Hospital","place":["Shaoxing, Zhejiang, 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