In-hospital resource utilization, worsening heart failure, and factors associated with length of hospital stay in patients with hospitalized heart failure: A Japanese database cohort study

BACKGROUND: Our objective was to characterize cases of hospitalized heart failure (HHF) focusing on in-hospital resource utilization (particularly furosemide doses) and worsening heart failure (WHF), and identify which factors are associated with the length of stay (LOS). METHODS: Cases of HHF (≥20 years), excluding those undergoing surgical procedures and in-hospital deaths, were retrieved from the Japanese Diagnosis Procedure Combination database (April 2012 to March 2016). WHF was defined using eight components, including up-titration of intravenous drugs and non-pharmacological management. RESULTS: The mean age of 78,953 cases of HHF was 79 years and 51% were male. The median LOS was 17 days. The maximum daily dose and cumulative dose of furosemide (mean ± standard deviation) were 43.3 ± 56.0 mg and 215.6 ± 450.6 mg, respectively, for intravenous furosemide, and 44.0 ± 37.3 mg and 523.3 ± 675.4 mg, respectively, for oral furosemide. The incidence of WHF was 36.1% during hospitalization and 19.3% from 6th hospital day to discharge. The mean number of WHF components was 1.4 ± 0.7 during hospitalization and 1.3 ± 0.6 from 6th hospital day. Regression analyses showed that the number of WHF components from 6th hospital day, pneumonia, and hyponatremia were strongly associated with longer LOS. CONCLUSIONS: These findings in patients with HHF could be vital to focus future efforts to improve the therapeutic strategies for heart failure.