title: Longer hospital length of stay is not related to better clinical outcomes in congestive heart failure.
abstract: Efforts to reduce hospital lengths of stay (LOS) are prevalent, despite limited understanding of the clinical impact of duration of hospitalization. Thus, we sought to evaluate the clinical relevance of LOS in congestive heart failure (CHF) by studying its relationship to inpatient and post-discharge outcomes among individuals with this disorder. Ten acute care community hospitals in New York State participated in this investigation. The study population consisted of 1,402 consecutive patients, predominantly elderly, who were hospitalized for evaluation and treatment of moderately severe or severe CHF. The patients' medical records were abstracted by trained personnel immediately after hospital discharge. Patients were followed forward for six month's time to track death and readmission rates, as well as functional status, quality of life, and satisfaction. Mean LOS for the group was 7.9 +/- 9.2 days. Longer LOS had a neutral or negative association with patient outcomes. Specifically, longer LOS was linked to a higher adjusted mortality rate during the index hospitalization, as well as a greater adjusted risk of death during the post-discharge period. Moreover, longer LOS was associated with worse post-discharge functional class and a trend for less patient satisfaction with their physicians' care. We conclude that death becomes more prevalent and functional measures decline in association with prolonged hospital stays for heart failure. Although these findings may be of use in planning management strategies, they offer no proof that reducing the costs of care will improve clinical outcomes in CHF.
authors.affiliation: Cardiovascular Division, Henry Ford Hospital, Detroit, MI 48202-2689, USA.
authors.forename: E F
authors.initials: EF
authors.lastname: Philbin
authors.forename: J B
authors.initials: JB
authors.lastname: Roerden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006764:Hospitals, Community / Q000592:standards; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009518:New York; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data