Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study
Por:
Miró Ò, Padrosa J, Takagi K, Gayat É, Gil V, Llorens P, Martín-Sánchez FJ, Herrero-Puente P, Jacob J, Montero MM, Díez MPL, Traveria L, Torres-Gárate R, Agüera C, Peacock WF, Bueno H, Mebazaa A, ICA-SEMES Research Group, Fuentes M, Gil C, Alonso H, Garmila P, García GL, Yáñez-Palma MC, López SI, Escoda R, Xipell C, Sánchez C, Gaytan JM, Pérez-Durá MJ, Salvo E, Pavón J, Noval A, Torres JM, López-Grima ML, Valero A, Juan MÁ, Aguirre A, Morales JE, Masó SM, Alonso MI, Ruiz F, Franco JM, Mecina AB, Tost J, Sánchez S, Carbajosa V, Piñera P, Nicolás JAS, Garate RT, Alquezar A, Rizzi MA, Herrera S, Roset A, Cabello I, Richard F, Pérez JMÁ, Diez MPL, Álvarez JV, García BP, Sánchez González MGGY, Javaloyes P, Marquina V, Jiménez I, Hernández N, Brouzet B, Ramos S, López A, Andueza JA, Romero R, Ruíz M, Calvache R, Lorca MT, Calderón L, Arriaga BA, Sierra B, Mojarro EM, Bécquer LT, Burillo G, García LL, LaSalle GC, Urbano CA, Soto ABG, Padial ED, Ferrer ES, Garrido M, Lucas FJ, Gaya R, Bibiano C, Mir M, Rodríguez B, Sánchez N, Carballo JL, Rodríguez-Adrada E and Rodríguez B
Publicada:
1 dic 2019
Ahead of Print:
23 ago 2019
Categoría:
Internal medicine
Resumen:
Objective: To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation.
Methods: Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (< 6/6-10/11-15/ > 15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH > 6 days vs. LOH < 6 days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units.
Results: We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4-11): 2934 (34.3%) had a LOH < 6 days, 3184 (37.2%) 6-10 days, 1287 (15.0%) 11-15 days, and 1158 (13.5%) > 15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined end-point 37.4%. Mortality was increased by 36.5% (95%CI = 13.0-64.9) when LOH was 11-15 days, and by 72.0% (95%CI = 42.6-107.5) when > 15 days. Conversely, no differences were found in readmission risk, and the combined end-point only increased 21.6% (95%CI = 8.4-36.4) for LOH > 15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH > 15 days and no significant increments in readmission risk.
Conclusions: Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments.
Filiaciones:
Miró Ò:
Emergency Department, Hospital Clínic, Barcelona
"Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy
Padrosa J:
Emergency Department, Hospital Clínic, Barcelona
"Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
Takagi K:
Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
Gayat É:
Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
Gil V:
Emergency Department, Hospital Clínic, Barcelona
"Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
Llorens P:
Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
Martín-Sánchez FJ:
Emergency Department, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Spain
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
Herrero-Puente P:
Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Jacob J:
Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
Montero MM:
Emergency Department, Hospital Universitario Infanta Leonor, Madrid, Spain
Díez MPL:
Emergency Department, Hospital Universitario de Burgos, Burgos, Spain
Traveria L:
Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain
Torres-Gárate R:
Emergency Department, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
Agüera C:
Emergency Department, Hospital Costa del Sol, Marbella, Málaga, Spain
Peacock WF:
The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy
Emergency Department, Baylor College of Medicine, Ben Taub General Hospital, Houston, USA
Bueno H:
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
Cardiology Department, Universidad Complutense, Hospital 12 de Octubre, Madrid, Spain
Mebazaa A:
The GREAT (Global REsearch in Acute Cardiovascular Conditions Team) Network, Rome, Italy
Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisière University Hospital, Université Paris Diderot, Paris, France
Fuentes M:
Hospital Universitario de Salamanca, Spain
Gil C:
Hospital Universitario de Salamanca, Spain
Alonso H:
Hospital Marqués de Valdecilla de Santander, Spain
Garmila P:
Hospital Marqués de Valdecilla de Santander, Spain
García GL:
Hospital Clínico San Carlos de Madrid,Spain
Yáñez-Palma MC:
Hospital Clínico San Carlos de Madrid,Spain
López SI:
Hospital Clínico San Carlos de Madrid,Spain
Escoda R:
Hospital Clínic de Barcelona, Spain
Xipell C:
Hospital Clínic de Barcelona, Spain
Sánchez C:
Hospital Clínic de Barcelona, Spain
Gaytan JM:
Hospital Clínic de Barcelona, Spain
Pérez-Durá MJ:
Hospital Politénic La Fe de Valencia, Spain
Salvo E:
Hospital Politénic La Fe de Valencia, Spain
Pavón J:
Hospital Dr. Negrín de Las Palmas de Gran Canaria, Spain
Noval A:
Hospital Insular de Las Palmas de Gran Canaria, Spain
Torres JM:
Hospital Reina Sofía de Córdoba, Spain
:
Hospital Dr. Peset de Valencia, Spain
:
Emergency Department, Hospital Doctor Peset, Valencia, Spain
Hospital Dr. Peset de Valencia, Spain
Juan MÁ:
Hospital Dr. Peset de Valencia, Spain
Aguirre A:
Hospital del Mar de Barcelona, Spain
Morales JE:
Hospital del Mar de Barcelona, Spain
Masó SM:
Hospital del Mar de Barcelona, Spain
Alonso MI:
Emergency Department, Hospital Valme, Sevilla, Spain
Hospital de Valme de Sevilla, Spain
Ruiz F:
Hospital de Valme de Sevilla, Spain
Franco JM:
Hospital Miguel Servet de Zaragoza, Spain
Mecina AB:
Hospital de Alcorcón de Madrid, Spain
Tost J:
Emergency Department, Hospital de Terrassa, Barcelona, Catalonia, Spain
Consorci Sanitari de Terrassa, Spain
Sánchez S:
Hospital Rio Ortega de Valladolid, Spain
Carbajosa V:
Hospital Rio Ortega de Valladolid, Spain
Piñera P:
Hospital Reina Sofía de Murcia, Spain
Nicolás JAS:
Hospital Reina Sofía de Murcia, Spain
Garate RT:
Hospital Severo Ochoa de Madrid, Spain
Alquezar A:
Hospital de la Santa Creu y Sant Pau de Barcelona, Spain
Rizzi MA:
Hospital de la Santa Creu y Sant Pau de Barcelona, Spain
Herrera S:
Hospital de la Santa Creu y Sant Pau de Barcelona, Spain
Roset A:
Hospital Universitari de Bellvitge de Barcelona, Spain
Cabello I:
Hospital Universitari de Bellvitge de Barcelona, Spain
Richard F:
Hospital Universitario de Burgos, Spain
Pérez JMÁ:
Hospital Universitario de Burgos, Spain
Diez MPL:
Hospital Universitario de Burgos, Spain
Álvarez JV:
Hospital Universitario Central de Asturias de Oviedo, Spain
García BP:
Hospital Universitario Central de Asturias de Oviedo, Spain
Sánchez González MGGY:
Hospital Universitario Central de Asturias de Oviedo, Spain
Javaloyes P:
Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
Hospital General de Alicante, Spain
Marquina V:
Hospital General de Alicante, Spain
Jiménez I:
Hospital General de Alicante, Spain
Hernández N:
Hospital General de Alicante, Spain
Brouzet B:
Hospital General de Alicante, Spain
Ramos S:
Hospital General de Alicante, Spain
López A:
Hospital General de Alicante, Spain
Andueza JA:
Hospital General Universitario Gregorio Marañón de Madrid, Spain
Romero R:
Hospital Getafe de Madrid, Spain
Ruíz M:
Hospital de Henares de Madrid, Spain
Calvache R:
Hospital de Henares de Madrid, Spain
Lorca MT:
Hospital del Tajo de Madrid, Spain
Calderón L:
Hospital del Tajo de Madrid, Spain
Arriaga BA:
Hospital Clínico Lozano Blesa de Zaragoza, Spain
Sierra B:
Hospital Clínico Lozano Blesa de Zaragoza, Spain
Mojarro EM:
Hospital Sant Pau i Santa Tecla de Tarragona, Spain
Bécquer LT:
Hospital Universitario de Canarias de Tenerife, Spain
Burillo G:
Hospital Universitario de Canarias de Tenerife, Spain
García LL:
Hospital Universitari de Vic de Barcelona, Spain
LaSalle GC:
Hospital Universitari de Vic de Barcelona, Spain
Urbano CA:
Hospital Costa del Sol de Marbella de Málaga, Spain
Soto ABG:
Hospital Costa del Sol de Marbella de Málaga, Spain
Padial ED:
Hospital Costa del Sol de Marbella de Málaga, Spain
Ferrer ES:
Hospital Josep Trueta de Girona, Spain
Garrido M:
Hospital Virgen Macarena de Sevilla, Spain
Lucas FJ:
Hospital General de Albacete, Spain
Gaya R:
Hospital Juan XXIII de Tarragona, Spain
Bibiano C:
Hospital Infanta Leonor de Madrid, Spain
Mir M:
Hospital Infanta Leonor de Madrid, Spain
Rodríguez B:
Hospital Infanta Leonor de Madrid, Spain
Sánchez N:
Hospital Infanta Leonor de Madrid, Spain
Carballo JL:
Complejo Hospitalario Universitario de Ourense, Spain
Rodríguez-Adrada E:
Hospital Rey Juan Carlos de Mostoles de Madrid, Spain
Rodríguez B:
Hospital Rey Juan Carlos de Mostoles de Madrid, Spain
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