| Summary: | Background: Deficiency in vitamin D<sub>3</sub> and its metabolites has been linked to dismal outcomes in patients with chronic diseases, including cardiovascular disease and heart failure (HF). It remains unclear if a vitamin D<sub>3</sub> status is a prognostic feature in patients with acute decompensated HF. Methods: We assessed serum levels of 25-OH-vitamin D<sub>3</sub> and 1,25-(OH)<sub>2</sub>-vitamin D<sub>3</sub> in 139 patients with acute HF who had been admitted to the intermediate care unit of a maximum care hospital. The follow-up period was one year. After exclusion of patients with sampling errors and those who were lost to follow-up, 118 patients remained in the final study cohort. Outcome estimates by 25-OH-vitamin D<sub>3</sub> and 1,25-(OH)<sub>2</sub>-vitamin D<sub>3</sub> levels were compared to the Seattle Heart Failure (SHF) Model. Results: More than two-thirds (79.7%) of the patients showed inadequate 25-OH-vitamin D<sub>3</sub> levels (i.e., <30 ng/mL) upon admission. Low levels of 1,25-(OH)<sub>2</sub>-vitamin D<sub>3</sub> (i.e., <19.9 pg/mL) were observed in 16.1% of patients. Of the 118 HF patients, 22 (19%) died during the following 12 months. There were no differences in vitamin D<sub>3</sub> levels between patients who died and those who survived, neither in 25-OH-vitamin D<sub>3</sub> (23.37 ± 19.14 ng/mL vs. 19.11 ± 12.25 ng/mL; <i>p</i> = 0.19) nor in 1,25-(OH)<sub>2</sub>-vitamin D<sub>3</sub> levels (31.10 ± 19.75 ng/mL vs. 38.25 ± 15.73 ng/mL; <i>p</i> = 0.02); therefore, vitamin D<sub>3</sub> levels alone did not predict one-year survival (AUC [25-OH-vitamin D<sub>3</sub>] 0.50; 95% CI 0.34–0.65; AUC [1,25-(OH)2-vitamin D<sub>3</sub>] 0.62; 95% CI 0.48–0.76). Moreover, whilst the SHF model exhibited acceptable discriminatory ability for predicting one-year mortality (AUC 0.79; 95% CI 0.66–0.91), adding vitamin D levels on admission to the SHF score did not improve its discriminatory value. Conclusion: Our data do not support the use of vitamin D<sub>3</sub> screening in patients admitted with acute decompensated HF to aid prognostication.
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