Influence of Hospital Length of Stay for Heart Failure on Quality of Care

Krantz, Mori J.; Tanner, Justin; Horwich, Tamara B.; Yancy, Clyde W.; Albert, Nancy M.; Hernandez, Adrian F.; Dai, David; Fonarow, Gregg C.

doi:10.1016/j.amjcard.2008.08.015

Cited by 21 publications

(20 citation statements)

References 22 publications

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“…Existing research on length of hospital stay is very limited and focuses on economic outcomes, predictors of length of hospital stay, or effect on quality-of-care measures [9,13,[15][16][17]. To the best of our knowledge, this is the first analysis of a voluntary large registry indicating that the length of hospitalisation might be regarded as a marker of poor prognosis in HF.…”

Section: Discussionmentioning

confidence: 99%

“…Generally, patients with longer duration of stay have more comorbidities, higher severity of disease, and a greater number of procedures performed [13,17,19]. It is clear that decompensated HF patients who require longer hospitalisation are in a more serious condition and need longer treatment to recover [6,22].…”

Section: Discussionmentioning

confidence: 99%

“…The differences in the length of hospital stay probably reflect varying care management, health care systems, and improved prevention of HF [2,4,[9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Hospitalisation length and prognosis in heart failure patients

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hospitalisation length and prognosis in heart failure patients

et al. 2017

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“…Of note, length of stay has previously been demonstrated to influence rate of LVEF assessment. 16,17 As such, the ACC/AHA LVEF assessment performance measure gives credit for AMI patients with a documented plan for LVEF testing after discharge, given potentially limited opportunities to test during abbreviated hospital stays or weekend admissions. Although our study did not capture intent for postdischarge LVEF assessment, we found no significant difference in weekday versus weekend presentation or length of stay between patients with and without LVEF assessment.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Ejection Fraction Assessment Among Patients With Acute Myocardial Infarction and Its Association With Hospital Quality of Care and Evidence-Based Therapy Use

Miller

Dib

et al. 2012

Circ: Cardiovascular Quality and Outcomes

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Background-The left ventricular ejection fraction (LVEF) has prognostic and therapeutic utility after acute myocardial infarction (AMI). Although LVEF assessment is a key performance measure among AMI patients, contemporary rates of in-hospital assessment and its association with therapy use have not been well characterized. Methods and Results-We examined rates of in-hospital LVEF assessment among 77 982 non-ST-elevation myocardial infarction patients and 50 863 ST-elevation myocardial infarction patients in Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines between January 2007 and September 2009, after excluding patients who died in-hospital or who were transferred to another acute care facility, discharged to end-of-life care, or had missing LVEF assessment status. LVEF assessment increased significantly over time, with higher rates among STelevation myocardial infarction than non-ST-elevation myocardial infarction patients (95.1% versus 91.6%; P<0.001).Excluding patients with prior heart failure did not alter these observations. Significant interhospital variability in LVEF assessment rates was observed. Compared with patients with in-hospital LVEF assessment, patients who did not have LVEF assessed were older and more likely to have clinical comorbidities. In multivariable modeling, lower overall hospital quality of AMI care was also associated with lower likelihood of LVEF assessment (odds ratio for failure to assess LVEF, 1.09; 95% confidence interval, 1.05-1.13 per 10% decrease in defect-free care). Patients with in-hospital LVEF assessment were more likely to be discharged on evidence-based secondary prevention medication therapies compared with patients without LVEF assessment. Conclusions-The assessment of LVEF among patients with AMI has improved significantly over time, yet significant interhospital variability exists. Patients who did not have in-hospital LVEF assessment were less likely to receive evidence-based medications at discharge. These patients represent targets for future quality improvement efforts. (Circ Cardiovasc Qual Outcomes. 2012;5:662-671.)

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“…although the armamentarium of medications that reduce mortality among patients with HF has grown, the relative number of eligible patients receiving these therapies remains low. 2,3 testing for natriuretic peptide markers, such as B-type natriuretic peptide (BnP), or its amino-terminal fragment n-terminal proBnP (nt-proBnP), has emerged as an important tool for the diagnosis and risk stratification of patients with HF. However, questions remain regarding the use of natriuretic peptides to help guide therapy in patients with HF.…”

Section: Introductionmentioning

confidence: 99%

Natriuretic peptides in heart failure: should therapy be guided by BNP levels?

O’Donoghue

Braunwald

2009

Nat Rev Cardiol

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Heart failure (HF) is a leading cause of morbidity and mortality worldwide. Testing for natriuretic peptide markers, such as B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP), has emerged as an important tool for the diagnosis and risk stratification of patients with HF. However, questions remain regarding the potential role for natriuretic peptides to guide therapy in patients with HF. In this Review, we address the underlying assumptions and the existing evidence supporting a natriuretic-peptide-guided approach to the outpatient management of HF.

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Influence of Hospital Length of Stay for Heart Failure on Quality of Care

Cited by 21 publications

References 22 publications

Hospitalisation length and prognosis in heart failure patients

Hospitalisation length and prognosis in heart failure patients

Left Ventricular Ejection Fraction Assessment Among Patients With Acute Myocardial Infarction and Its Association With Hospital Quality of Care and Evidence-Based Therapy Use

Natriuretic peptides in heart failure: should therapy be guided by BNP levels?

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