Highlights
- •LOS was associated with the risk of very early readmission in patients discharged from AHF.
- •At 10 and 15 days, both longer and shorter LOS were associated with an increased risk of readmission.
- •At 30 days, longer but no shorter LOS showed a modest increased risk of readmission.
Abstract
Introduction and objectives
In patients admitted for acute heart failure (AHF), optimal length of stay (LOS) remains
controversial. Longer hospitalizations are associated with worse prognosis, but little
is known about short hospitalizations. The aim of this work was to evaluate the relationship
between LOS and the risk of short-term readmission in patients discharged after a
hospitalization for AHF.
Methods
We included 2110 consecutive patients. The independent associations between LOS and
unplanned 10, 15 and 30-day readmissions were evaluated by Cox regression analysis
adjusted for competing events. LOS was categorized as LOS1: ≤4 days, LOS2: 5–7 days, LOS3: 8–10 days, and LOS4: >10 days.
Results
The mean age was 73 ± 11 years and 52.6% exhibited left ventricle ejection fraction ≥ 50%. The median (IQR) LOS was 7 (5–11) days. At 10, 15 and 30-day follow-up, 130 (6.2%),
181 (8.6%), and 282 (13.4%) unplanned readmissions were registered. Rates of 10 and
15-day readmission among LOS categories showed a J-shaped pattern with lower rates
for those in LOS2 and higher at the both extremes (p = 0.001). At 30-day, only longer stays showed higher rates of readmission (p = 0.002). In the multivariate analysis, the U-shaped curve remained significant for
10 and 15-day readmissions (p < 0.05). Compared to LOS2, LOS1, LOS3 and LOS4 showed about two-fold increased risk.
At 30-day only longer stays showed a borderline and modest increase of risk.
Conclusions
Shorter and longer stays are associated with the risk of very early readmissions after
an episode of AHF. These associations are marginal for 30-day readmissions.
Abbreviations:
AHF (acute heart failure), HF (heart failure), LOS (length of stay), LVEF (left ventricle ejection fraction), NT-proBNP (amino-terminal pro-brain natriuretic peptide)Keywords
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Article info
Publication history
Published online: April 08, 2017
Accepted:
April 6,
2017
Received in revised form:
March 22,
2017
Received:
November 19,
2016
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
