Hospitalisation length and prognosis in heart failure patients

Abstract

A b s t r a c tBackground: Heart failure (HF) is a chronic disease with poor prognosis, being the final stage of many cardiovascular conditions and often requiring hospitalisation. Aim:The aim of the study was to evaluate the effect of hospitalisation length on prognosis in patients with HF. Methods:Between February 2012 and January 2013, in 32 cardiology centres in Poland, 1126 HF patients were included in the EURObservational Research Programme on Heart Failure Registry. A total of 765 persons were hospitalised. A follow-up (FU) of 414 ± 121 days was conducted. Results:The median length of hospitalisation was seven days (interquartiles 25 th-75 th; 4-11), also for new onset (14.5% of patients) and chronic HF (seven days, 5-11 and 4-11, respectively). Patients who died during FU (16.5%) and those who survived were hospitalised for a median of eight days (6-12) and seven days (4-10), respectively (p < 0.001). Patients hospitalised for 8-21 and 22 or more days had an increased risk of death after discharge (hazard ratio [HR] 1.70; 95% confidence interval [CI] 1.16-2.49 and HR 2.20; 95% CI 1.04-4.67, respectively) than those hospitalised for up to seven days. Predictors of death in the FU period in multivariate analysis included age (1.02; 95% CI 1.01-1.04), history of chronic kidney disease (CKD) (HR 1.55; 95% CI 1.05-2.30), and New York Heart Association (NYHA) class III (HR 2.52; 95% CI 1.22-5.18) and IV (HR 4.77; 95% CI 2.32-9.82) at admission. Patients hospitalised for 22 or more days were more often male (77%), and with a history of CKD (34%). At admission they had lower systolic (118 ± 25 mm Hg) and diastolic (72 ± 12 mm Hg) blood pressure, higher NT-proBNP (9191 ± 8776 pg/mL), lower serum sodium level (137 ± 5 mmol/l), as well as lower ejection fraction before and during hospital stay (30 ± 12% and 34 ± 14%, respectively; p < 0.05 for all factors). Factors that influenced the length of hospital stay included history of CKD (p < 0.001), current malignancy (p = 0.026), and infection at admission (p < 0.001). Most of the admitted patients presented NYHA class III (45%). The poorer the NYHA class at admission, the longer the patient's hospital stay (p < 0.001). 54% patients were re-admitted to the hospital during FU. Patients re-admitted and not re-admitted during the one-year FU had the same median duration of the index hospitalisation (seven days; 4-10 and 4-11, respectively; p = 0.957). Conclusions:Patients with HF hospitalised for 22 or more days, in comparison to patients hospitalised for less than eight days, had double the risk of death during FU. We believe that prolonged hospitalisation might be regarded as a marker of poor prognosis in patients with acute HF.

Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study

“…This finding is in line with recent data from a Polish study of 765 patients discharged from 32 cardiology wards. In this study, mortality increased 120% during an average 414-day follow-up in patients with an index hospitalisation exceeding 21 days compared to patients hospitalised < 7 days [17]. Similarly, Sud et al reported a 28% increase in 30-day all-cause mortality in 58,230 AHF patients admitted to any hospital ward (not only cardiology) in Ontario, Canada for 9 days or more compared with those with a LOH of 5-6 days [18].…”

The utility of the adjusted-OPTIMIZE-HF risk model for predicting in-hospital length of stay in the Chinese population

“…Studies by Formiga et al (26) and Zaprutko et al (27) confirmed that the New York Heart Association (NYHA) classification of patients with HF was independently related to LOS, and it was included in many risk models used to predict patient mortality. This variable was not included in our study because it was unavailable in our dataset.…”

Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure

“…The NYHA functional classification is a well-known practical measure of severity in patients with heart failure [ 32 , 33 , 34 , 35 , 36 ]. The classification is based on the severity of symptoms and limitation of physical activities.…”