Evaluation of clinical and demographic characteristics and their association with length of hospital stay in patients admitted to cardiac intensive care unit with the diagnosis of acute heart failure

Abstract

Akut kalp yetersizliği nedeni ile kardiyoloji yoğun bakım ünitesine yatırılan hastaların klinik ve demografik özelliklerinin ve bu özelliklerin hastanede kalış süresi ile ilişkisinin incelenmesiEvaluation of clinical and demographic characteristics and their association with length of hospital stay in patients admitted to cardiac intensive care unit with the diagnosis of acute heart failure ABSTRACTObjective: Despite increasing incidence, data regarding clinical and demographic characteristics of patients with acute heart failure (AHF) admitted to cardiac intensive care unit (ICU) are inconclusive. The aim of this study was to assess the presentation characteristics and factors determining the length of hospital stay in this particular patient population. Methods: We conducted a single-center, prospective study involving 150 patients hospitalized to cardiac ICU with the primary diagnosis of AHF. Chi-square and Student t tests were used for the analysis of categorical and continuous variables, respectively. Linear regression analysis (LRA) was used to determine the factors affecting the length of hospital stay.Results: Forty-nine percent of the patients had new-onset AHF and 25% had preserved left ventricular ejection fraction (LVEF). In 25.3% of all patients and 46.6% of the patients with new-onset HF the precipitating factor was acute coronary syndrome. Atrial fibrillation and valvular heart disease as precipitating factors were more common in patients with preserved EF, when compared to low EF group. LRA showed that presence of anemia [β=1.62; 95% CI 0.08-3.15; p=0.039)] and severe mitral regurgitation (β=2.55; 95% CI 0.06-5.05; p=0.045) and systolic blood pressure (β=-0.03; 95% CI -0.06 --0.002; p=0.039) and blood urea nitrogen (β=0.034; 95% CI 0.006 -0.06; p=0.016) were the independent predictors of length of stay. GirişKalp yetersizliği (KY), ülkemizde ve tüm Dünya'da en önemli ölüm nedenleri arasında yer almaktadır (1-4). Altmış beş yaş üstü hastalarda hastaneye yatışların en sık nedeni akut KY'dir (AKY) (5). Tedavi yöntemlerindeki ilerlemeler sonucunda kronik KY nedeniyle ayaktan takip edilen hastaların ölüm oranlarında azalma sağlanmasına rağmen, AKY nedeni ile hastaneye yatırılan hastaların hastane içi ve taburcu sonrası ölüm oranlarındaki yükseklik devam etmektedir (6). Kalp yetersizliği nedeni ile hastaneye yatırı-lan hastaların yaklaşık %50'si taburcu olduktan sonra ilk yıl içinde aynı tanı ile tekrar hastaneye yatırılmaktadır (7). Bu hastaların bir yıl içinde kaybedilme oranları ayaktan takip edilen hastalardan daha yüksektir (8).Yüksek görülme sıklığına, kötü seyrine ve ekonomik yönden oluşturduğu ağır yüke rağmen AKY nedeniyle hastaneye yatırı-lan hastalarla ilgili epidemiyolojik çalışmalar ancak yakın zamanda yapılmıştır (9-13).Bu hasta grubuna ait ülkemizdeki verilerin yetersizliğini dikkate alarak kardiyoloji yoğun bakım ünitemize AKY nedeni ile yatırılan hastaların demografik ve klinik özelliklerinin ve hastanede yatış süresini etkileyen faktörlerin incelendiği ileriye dönük, gözlemsel bir ça...

Chronic beta blocker therapy before admission influences length of hospital stay among patients with acutely decompensated heart failure

“…In this present study, compatible with the results of the previous studies, AF, higher creatinine and lower sodium were demonstrated to be associated with prolonged LOS independent from other factors (30,39,40). In addition, considering that the comorbidities increase with increased age, it is not surprising for LOS to be prolonged (30,41). While anemia demonstrated as an independent predictor for prolonged LOS in some studies, lower hemoglobin was significantly associated with prolonged LOS in the univariate analysis in the present study but It was demonstrated to lose its significance in the multivariate analysis (30,41).…”

“…In addition, considering that the comorbidities increase with increased age, it is not surprising for LOS to be prolonged (30,41). While anemia demonstrated as an independent predictor for prolonged LOS in some studies, lower hemoglobin was significantly associated with prolonged LOS in the univariate analysis in the present study but It was demonstrated to lose its significance in the multivariate analysis (30,41). In this study, contrary to other previous studies on this subject, preadmission BB, ACEI/ARB, MRA, and diuretic use were also evaluated, and only BB use among all the drugs was found to be associated with prolonged LOS in both the univariate and multivariate analyses.…”

Cancer Antigen 125 is Associated with Length of Stay in Patients with Acute Heart Failure

“…Whellan and colleagues' study 27 of 70,000 patients found that factors such as AF, COPD, DM, chronic renal failure, female sex, low systolic blood pressure, high heart rate, and low levels of hemoglobin, high levels of BUN, and high levels of brain natriuretic peptide were associated with prolonged LOS. Sahin and associates 38 found that low systolic blood pressure, high BUN, anemia, and severe mitral insufficiency at the time of admission were independently associated with LOS. In patients older than age 65 years, only female sex and poor functional class at the time of hospitalization were found to be correlated with LOS.…”

Post-discharge heart failure monitoring program in Turkey: Hit-PoinT

“…The recently published EURObservational Research Programme Heart Failure Pilot Survey demonstrated that the rate of 1-year mortality or rehospitalization was 36% in hospitalized HF patients and 18% in chronic HF patients ( 5 ). These large numbers, and repeated prolonged hospitalizations for HF, also create a substantial economic burden on the health care system ( 6 ). Therefore, HF requires special management strategies to overcome its worst clinical outcomes.…”