Gotsman I, et al. - In a real-world cohort of 5,779 heart failure (HF) patients, the prognostic significance of albumin levels was determined. The cohort had median serum albumin 4.0 g/dL (inter-quartile range 3.7-4.2) and hypoalbuminemia (albumin<3.5 g/dL) was present in 12% of the patients. Participants were followed-up for 576 days. The factors associated with low albumin included increasing age, higher urea and C-reactive protein, lower sodium, hemoglobin, iron, less treatment with angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, reduced right ventricular function and pulmonary hypertension. Findings revealed the contribution of low albumin in offering important information regarding several detrimental processes in HF. Decreasing quartiles of albumin was found to be significantly related to mortality in Cox regression analysis after adjustment for significant predictors. Also, increased cardiac-related hospitalizations were significantly predicted by decreasing quartiles of albumin. Cox regression analysis demonstrated a decrease in albumin on follow-up as an independent predictor of increased mortality.