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.
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