May 11, 2017JACC Heart Failure131 citationsOpen Access

Associations Between Short or Long Length of Stay and 30-Day Readmission and Mortality in Hospitalized Patients With Heart Failure

MSManeesh SudSunnybrook Health Science Centre BYBing YuCape Town HVTN Immunology Laboratory / Hutchinson Centre Research Institute of South Africa HWHarindra C. WijeysunderaInterventional / Structural Cardiology

Structured PICO

Does short or long hospital length of stay affect 30-day readmission and mortality in older patients hospitalized with heart failure?

Population

58,230 patients with heart failure (age >65 years) in Ontario, Canada

Intervention

Short (1 to 2 days) or long (9 to 14 days) hospital length of stay

Comparator

5 to 6 days hospital length of stay (reference)

Outcome

30-day readmissions (cardiovascular, HF, noncardiovascular) and 30-day mortalityhard clinical

Both short and long hospital lengths of stay for heart failure are associated with increased 30-day cardiovascular readmissions, demonstrating a U-shaped relationship.

Abstract

OBJECTIVES: This study sought to examine the associations between heart failure (HF)-related hospital length of stay and 30-day readmissions and HF hospital length of stay and mortality rates. BACKGROUND: Although reducing HF readmission and mortality rates are health care priorities, how HF-related hospital length of stay affects these outcomes is not fully known. METHODS: A population-level, multicenter cohort study of 58,230 patients with HF (age >65 years) was conducted in Ontario, Canada between April 1, 2003 and March 31, 2012. RESULTS: When length of stay was modeled as continuous variable, its association with the rate of cardiovascular readmission was nonlinear (p < 0.001 for nonlinearity) and U-shaped. When analyzed as a categorical variable, there was a higher rate of cardiovascular readmission for short (1 to 2 days; adjusted hazard ratio HR: 1.12; 95% confidence interval CI: 1.04 to 1.21; p = 0.003) and long (9 to 14 days; HR: 1.11; 95% CI: 1.04 to 1.19; p = 0.002) lengths of stay as compared with 5 to 6 days (reference). Hospital readmissions for HF demonstrated a similar nonlinear (p = 0.005 for nonlinearity) U-shaped relationship with increased rates for short (HR: 1.15; 95% CI: 1.04 to 1.27; p = 0.006) and long (HR: 1.14; 95% CI: 1.04 to 1.25; p = 0.004) lengths of stay. Noncardiovascular readmissions demonstrated increased rates with long (HR: 1.17; 95% CI: 1.07 to 1.29; p < 0.001) and decreased rates with short (HR: 0.87; 95% CI: 0.79 to 0.96; p = 0.006) lengths of stay (p = 0.53 for nonlinearity). The 30-day mortality risk was highest after a long length of stay (HR: 1.28; 95% CI: 1.14 to 1.43; p < 0.001). CONCLUSIONS: A short length of stay after hospitalization for HF is associated with increased rates of cardiovascular and HF readmissions but lower rates of noncardiovascular readmissions. A long length of stay is associated with increased rates of all types of readmission and mortality.

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