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

Miró, Ò. ; Padrosa, J. ; Takagi, K. ; Gayat, É. ; Gil, V. ; Llorens, P. ; Martín-Sánchez, F.J. ; Herrero-Puente, P. ; Jacob, J. ; Montero, M.M. ; Tost, J. ; Díez, M.P.L. ; Traveria, L. ; Torres-Gárate, R. ; Alonso, M.I. ; Agüera, C. ; Valero, A. ; Javaloyes, P. ; Peacock, W.F. ; Bueno, H. ; Mebazaa, A. ; Fuentes, M. ; Gil, C. ; Alonso, H. ; Garmila, P. ; García, G.L. ; Yáñez-Palma, M.C. ; López, S.I. ; Escoda, R. ; Xipell, C. ; Sánchez, C. ; Gaytan, J.M. ; Pérez-Durá, M.J. ; Salvo, E. ; Pavón, J. ; Noval, A. ; Torres, J.M. ; López-Grima, M.L. ; Juan, M.Á. ; Aguirre, A. ; Morales, J.E. ; Masó, S.M. ; Ruiz, F. ; Franco, J.M. ; Mecina, A.B. ; Sánchez, S. ; Carbajosa, V. ; Piñera, P. ; Nicolás, J.A.S. ; Garate, R.T. ; Alquezar, A. ; Rizzi, M.A. ; Herrera, S. ; Roset, A. ; Cabello, I. ; Richard, F. ; Pérez, J.M.Á. ; Diez, M.P.L. ; Álvarez, J.V. ; García, B.P. ; Sánchez González, M.G.G.Y. ; Marquina, V. ; Jiménez, I. ; Hernández, N. ; Brouzet, B. ; Ramos, S. ; López, A. ; Andueza, J.A. ; Romero, R. ; Ruíz, M. ; Calvache, R. ; Lorca, M.T. ; Calderón, L. ; Arriaga, B.A. (Universidad de Zaragoza) ; Sierra, B. (Universidad de Zaragoza) ; Mojarro, E.M. ; Bécquer, L.T. ; Burillo, G. ; García, L.L. ; LaSalle, G.C. ; Urbano, C.A. ; Soto, A.B.G. ; Padial, E.D. ; Ferrer, E.S. ; Garrido, M. ; Lucas, F.J. ; Gaya, R. ; Bibiano, C. ; Mir, M. ; Rodríguez, B. ; Sánchez, N. ; Carballo, J.L. ; Rodríguez-Adrada, E. ; Rodríguez, B.

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 endpoint 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 endpoint 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.

Idioma: Inglés

DOI: 10.1016/j.ejim.2019.08.007

Año: 2019

Publicado en: EUROPEAN JOURNAL OF INTERNAL MEDICINE 70 (2019), 24-32
ISSN: 0953-6205

Factor impacto JCR: 4.329 (2019)

Categ. JCR: MEDICINE, GENERAL & INTERNAL rank: 26 / 165 = 0.158 (2019) - Q1 - T1

Factor impacto SCIMAGO: 1.017 - Internal Medicine (Q2)

Financiación: info:eu-repo/grantAgreement/ES/MSC-ISCIII-FEDER/PI15-00773
Financiación: info:eu-repo/grantAgreement/ES/MSC-ISCIII-FEDER/PI15-01019
Financiación: info:eu-repo/grantAgreement/ES/MSC-ISCIII-FEDER/PI18-00393
Financiación: info:eu-repo/grantAgreement/ES/MSC-ISCIII-FEDER/PI18-00456

Tipo y forma: Article (PostPrint)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)