Abstract: Objective To evaluate the cumulative effect of clustered unhealthy lifestyle factors on the risk of readmission for patients with chronic heart failure (CHF) within one year. Methods A prospective cohort was established consisting of 355 CHF patients admitted to the Department of Cardiology at Linquan County People's Hospital between May 2023 and April 2024. Unhealthy lifestyle factors were categorized into five dimensions: diet, physical activity, sleep, emotional status, and smoking/alcohol consumption. Based on these dimensions, a Unhealthy Lifestyle Syndrome Index (ULSI) was constructed, dividing patients into three groups according to the number of unhealthy behaviors: Low (0-1 item), moderate (2-3 items), and high (4-5 items). Patients were followed up for one year to record readmission events. The relationship between ULSI and readmission risk was analyzed using χ² tests, logistic regression, and trend analysis. Results A total of 355 patients were enrolled (13 lost to follow-up), and 63 (17.75%) were rehospitalized within 1 year. The readmission rates among the low, moderate, and high ULSI groups were 9.59% (7/73), 15.15% (30/198), and 30.95% (26/84), respectively, with statistically significant differences (χ²=14.277, P=0.001). Multivariate logistic regression analysis revealed that, after controlling for New York Heart Association (NYHA) functional class and medication adherence, patients in the high ULSI group had a significantly increased risk of readmission compared to those in the low group (OR=2.744, 95% CI: 1.025-7.346, P=0.045), while no significant difference was observed between the moderate group and the low group (OR=1.087, 95% CI: 0.426-2.771, P=0.862). Trend analysis further indicated that each increment in ULSI level was associated with an 81.5% increase in readmission risk(OR=1.815, 95% CI: 1.130-2.918, P=0.014). Conclusion The clustering of unhealthy lifestyle factors independently contributes to the risk of readmission in CHF patients within one year, with higher clustering levels corresponding to greater readmission risks. Multi-dimensional lifestyle assessment and comprehensive intervention should be emphasized in clinical practice.

Key words: Chronic heart failure, Readmission, Clustered unhealthy lifestyle, Cumulative effect