Key result
Short hospital stays (≤3 days) for congestive heart failure were associated with lower rates of acute kidney injury (0.4% vs 2.9%) and lower direct hospital costs ($6150 vs $17,127) than longer stays.
Why the study?
Two-thirds of CHF hospital admissions in the US, generally requiring ≤3 days, are solely for diuresis and may be avoidable, but detailed epidemiology and outcomes are not well described.
What are the characteristics, outcomes, and costs of patients with short versus long hospital length of stay for congestive heart failure?
Cross-Sectional (n=1,177,910)
Yes
What are the characteristics, outcomes, and costs of patients with short versus long hospital length of stay for congestive heart failure?
Nearly half of hospitalizations for congestive heart failure have a length of stay of 3 days or less and require no inpatient procedures, suggesting potential for more aggressive outpatient management to avoid admissions and reduce costs.
Answers are grounded in this paper and cite their sources.
Short-stay CHF admissions comprise 43% of principal-diagnosis cases with lower costs and complications; leaves open whether outpatient diuresis strategies can safely reduce hospitalizations.
Background: Congestive heart failure (CHF) hospitalizations cost the US $35 billion annually. Two-thirds of these admissions, generally requiring </=3 days in the hospital, are solely for the purpose of diuresis, and may be avoidable. Methods: Among patients discharged with CHF as the principal diagnosis (PD), we compared characteristics and outcomes between those with hospital length of stay (LOS) </=3 days (short, SLOS) and >3 days (long, LLOS) in a cross-sectional multicenter analysis within the 2018 National Inpatient Sample. We applied complex survey methods to calculate nationally representative results. Results: Among 4,979,350 discharges with any CHF code, 1,177,910 (23.7%) had CHF-PD, of whom 511,555 (43.4%) had SLOS. Patients with SLOS were younger (>/=65 years: 68.3% vs 71.9%), less likely covered by Medicare (71.9% vs 75.4%), and had a lower comorbidity burden (Charlson: 3.9 [2.1] vs 4.5 [2.2) than patients with LLOS; they less frequently developed acute kidney injury (0.4% vs 2.9%) or a need for mechanical ventilation (0.7% vs 2.8%). A higher proportion with SLOS than with LLOS underwent no procedures (70.4% vs 48.4%). Mean LOS (2.2 [0.8] vs 7.7 [6.5]), direct hospital costs ($6150 [$4413]) vs $17,127 [$26,936]), and aggregate annual hospital costs $3,131,560,372 vs $11,359,002,072) were all lower with SLOS than LLOS. All comparisons reached alpha = 0.001. Conclusion: Among patients admitted for CHF, nearly ½ have LOS </=3 days, and almost ¾ of them requires no inpatient procedures. A more aggressive outpatient heart failure management strategy may allow many patients to avoid hospitalizations and their potential complications and costs.
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Zilberberg et al. (2023) conducted a cross-sectional in Congestive heart failure (n=1,177,910). Short hospital length of stay (<=3 days) vs. Long hospital length of stay (>3 days) was evaluated on Acute kidney injury (p=<=0.001). Short hospital stays (≤3 days) for congestive heart failure were associated with lower rates of acute kidney injury (0.4% vs 2.9%) and lower direct hospital costs ($6150 vs $17,127) than longer stays.
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