Format

Send to

Choose Destination
JACC Heart Fail. 2017 Aug;5(8):578-588. doi: 10.1016/j.jchf.2017.03.012. Epub 2017 May 10.

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

Author information

1
Institute for Clinical Evaluative Sciences University Health Network, Toronto General Hospital, Toronto, Ontario, Canada.
2
Institute for Clinical Evaluative Sciences University Health Network, Toronto General Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Cardiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
3
Institute for Clinical Evaluative Sciences University Health Network, Toronto General Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Cardiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
4
Division of Cardiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
5
Institute for Clinical Evaluative Sciences University Health Network, Toronto General Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada.
6
University of Missouri, Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
7
Division of Cardiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre of the University Health Network, Toronto, Ontario, Canada.
8
Institute for Clinical Evaluative Sciences University Health Network, Toronto General Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre of the University Health Network, Toronto, Ontario, Canada; Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada. Electronic address: dlee@ices.on.ca.

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.

KEYWORDS:

heart failure; length of stay; mortality; readmissions

PMID:
28501521
DOI:
10.1016/j.jchf.2017.03.012
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center