Shuvy M, et al. - In a real-world cohort of patients with heart failure (HF), researchers assessed the impact of urinary albumin to creatinine ratio (UACR) on clinical outcome. All HF patients were followed for cardiac-related hospitalizations and death at a health maintenance organization. The study cohort consisted of 4,668 HF patients and was divided into 3 UACR-based groups: normal range albuminuria (2,085 patients; 45%), microalbuminuria (1,769 patients; 38%), and macroalbuminuria (814 patients; 17%). Both microalbuminuria and macroalbuminuria were linked to increasing age, diabetes mellitus, hypertension, peripheral vascular disease, atrial fibrillation, and NYHA class III/IV. Microalbuminuria and macroalbuminuria were directly related to reduced event-free survival from death as well as death and cardiovascular-hospitalizations. Cox regression analysis using restricted cubic splines showed an independent continuous rise in mortality with increasing albuminuria. Overall, the authors concluded that albuminuria provides important information about several harmful HF processes and is an important predictor of a worse outcome.