December 1, 2015Open Access
Right ventricular dysfunction as predictor of longer hospital stay in patients with acute decompensated heart failure: a prospective study in Indonesian population
Key Result
Right ventricular dysfunction (TAPSE ≤ 16 mm) independently predicted a longer hospital length of stay in patients with acute decompensated heart failure (HR 2.227).
Study Design
Type
Cohort (n=259)
Multicenter
No
Structured PICO
Does right ventricular dysfunction predict longer hospital length of stay in patients with acute decompensated heart failure?
P
Population
259 patients admitted with acute decompensated heart failure (ADHF) in an Indonesian population.
I
Intervention
Right ventricular dysfunction assessed by tricuspid annular plane systolic excursion (TAPSE ≤ 16 mm)
C
Comparator
Normal right ventricular function (TAPSE > 16 mm)
O
Outcome
Hospital length of stay (LOS)
Right ventricular dysfunction, assessed by TAPSE ≤ 16 mm, is an independent predictor of longer hospital length of stay in patients with acute decompensated heart failure.
Main Result
Effect estimate: HR 2.227 (95% CI 1.103-4.494)
p-value: p=0.026
Limitations
- Did not assess socio-cultural and economic factors, patient compliance, mobility, or readiness for discharge
- NT-proBNP was not analyzed due to national health insurance coverage limitations
- Excluded patients with severe tricuspid regurgitation
- Could not provide systolic pulmonary artery pressure (sPAP) measurement due to lack of data on inferior vena cava dilatation
- Did not assess the predictive performance of other echocardiographic indices of RV function
Abstract
BACKGROUND: Hospital length of stay (LOS) is a key determinant of heart failure hospitalization costs. Longer LOS is associated with lower quality of care measures and higher rates of readmission and mortality. Right ventricular (RV) dysfunction predicted poor outcomes in patients with stable chronic heart failure (CHF), however, its prognostic value in the acute decompensated heart failure (ADHF) patients has not been sufficiently clarified. This study investigated the prognostic value of RV dysfunction in predicting longer LOS in ADHF patients. METHODS: A prospective cohort study was conducted in National Cardiovascular Center Harapan Kita to all patients admitted with ADHF. Clinical data and baseline RV function assessed by tricuspid annular plane systolic excursion (TAPSE) were collected. Clinical comorbidities including malnutrition, pneumonia and worsening renal function (WRF) were monitored during hospitalization. The primary outcome was hospital LOS. Cox regression analysis was used to identify independent predictors for longer LOS. RESULTS: Two hundred and fifty-nine ADHF patients were included in this cohort study. On time-to-event analysis, diastolic blood pressure (HR = 1.011; 95 % CI = 1.004-1.018; p = 0.002), hemoglobin levels (HR = 1.102; 95 % CI = 1.045-1.162; p 16 mm. CONCLUSIONS: Right ventricular dysfunction, WRF and malnutrition are important predictors of longer LOS. This is the first study to describe that in ADHF patients, lower the TAPSE resulted in longer the LOS.