Abstract 323: Association of Heart Failure Length of Stay with Subsequent Re-Admission and All-Cause Mortality
Length of stay (LOS) during acute heart failure (AHF) hospitalizations may play an important role in the risk of subsequent re-hospitalization or mortality. The purpose of this study was to assess the association between AHF hospital LOS and risk of readmissions and mortality.
Methods: We identified all members of Kaiser Permanente (KP) in the Northwest, Southern California and Georgia regions who experienced an AHF hospitalization and were discharged alive in 2008-2011 (index hospitalization, n=20,009). We evaluated 3 study outcomes (subsequent re-hospitalization with a primary diagnosis of AHF, subsequent re hospitalization for any reason, and all-cause mortality) each over 1, 6 and 12 months following the index hospitalization. To isolate the independent contribution of LOS, we used KP’s comprehensive electronic medical records to construct multivariable logistic regression models that included a wide range of demographic and clinical characteristics (vital signs and laboratory values), comorbidities (inpatient and outpatient ICD-9-CM diagnoses), and selected pharmacotherapies.
Results: Patients were 53% male with mean age 74±13 years. The diverse sample included 15% African-Americans, 17% Hispanics and 58% Whites. Comorbidities were common prior to the index hospitalization for AHF (diabetes 41%, hypertension 85%, renal disease 50%, coronary artery disease 45%), and 51% had previously diagnosed heart failure (HF). The proportion of patients with an AHF re-hospitalization was 6.3%, 16.7% and 22.6%; with any re-hospitalization 21%, 47% and 59%; and 6.4%, 18.2% and 25.7% died within 1, 6 and 12 months, respectively. LOS of the index AHF hospitalization did not differ among those who did and did not experience an AHF e re-hospitalization within any of the 3 time frames. However, mean LOS of the index AHF hospitalization was longer for those who had any re-hospitalization within 1 month (4.3 vs. 3.6 days, p<0.001) or 6 months (3.9 vs. 3.6, p<0.001). Compared with survivors, LOS was significantly longer by 1-2 days among patients who died within any time frame (p<0.001 for all). Odds of mortality were 6% greater per index hospitalization day for all time periods.
Conclusions: In this large diverse sample of patients hospitalized for AHF, longer LOS during the index hospitalization was significantly associated with increased all-cause re-hospitalization within 1 or 6 months and with increased mortality for up to 12 months independent of comorbidities and cardiovascular risk factors.
Author Disclosures: G.A. Nichols: B. Research Grant; Significant; Novartis Pharmaceuticals, AstraZeneca LP, Bristol-Myers Squibb, Merck Sharpe & Dohme. K. Reynolds: B. Research Grant; Significant; Novartis Pharmaceuticals. M.G. Butler: B. Research Grant; Significant; Novartis Pharmaceuticals. T.M. Kimes: B. Research Grant; Significant; Novartis Pharmaceuticals. W. Chan: A. Employment; Significant; Novartis Pharmaceuticals.
- © 2014 by American Heart Association, Inc.