Patient journey after admission for acute heart failure: length of stay, 30-day readmission and 90-day mortality.
The course of patients following admission for acute heart failure (AHF) is of major importance to patients and healthcare providers. We examined predictors and associations of length of stay (LOS), 30-day post-discharge readmission and 90-day post-discharge mortality in 1990 patients enrolled in the PROTECT study.



PROTECT was a randomized study that examined the effect of the adenosine blocker rolofylline in patients within 24 h of admission for AHF with mild to moderate renal impairment. Geographic-region-adjusted multivariable models showed that LOS was only partly explained by the severity of heart failure (HF), comorbidities (diabetes mellitus, renal impairment, ischaemic heart disease) and degree of metabolic dysfunction (cholesterol and albumin) at baseline (adjusted R(2) 0.27). Addition of in-hospital worsening heart failure (WHF) and changes in metabolic markers contributed significantly to prediction of LOS [R(2) difference 0.050, 95% confidence interval (CI) 0.0282-0.072]. Thirty-day HF readmission was associated with more severe HF and previous HF admission but not with LOS (odds ratios 1.00, 95% CI 0.97-1.04). Death within 90 days after discharge was associated with older age, more severe HF, worse renal function, and lower sodium and bicarbonate at admission; LOS was a strong predictor of 90-day post-discharge mortality.



In patients admitted for AHF, LOS is not well-predicted by traditional markers of disease severity, but strongly associated with the occurrence of in-hospital WHF. Longer LOS is a strong predictor of early mortality after discharge but not of readmission. These findings may help focus efforts to reduce LOS and post-discharge outcomes on patients' subgroups at increased risk.
Momentum Research, Inc., 3100 Tower Boulevard, Suite 802, Durham, NC, 27707, USA.
Beth A
BA
Davison
University of Brescia, Brescia, Italy.
Marco
M
Metra
Momentum Research, Inc., 3100 Tower Boulevard, Suite 802, Durham, NC, 27707, USA.
Stefanie
S
Senger
Momentum Research, Inc., 3100 Tower Boulevard, Suite 802, Durham, NC, 27707, USA.
Christopher
C
Edwards
Momentum Research, Inc., 3100 Tower Boulevard, Suite 802, Durham, NC, 27707, USA.
Olga
O
Milo
Merck Research Laboratories, Rahway, NJ, USA.
Daniel M
DM
Bloomfield
University of Hull, Kingston upon Hull, and National Heart and Lung Institute, Imperial College, London, UK.
John G
JG
Cleland
University of Iowa Carver College of Medicine Cardiovascular Research Centre, Iowa City, IA, USA.
Howard C
HC
Dittrich
Brigham and Women's Hospital, Boston, MA, USA.
Michael M
MM
Givertz
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
Christopher M
CM
O'Connor
University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
Barry M
BM
Massie
Klinika Kardiologii, Wroclaw, Poland.
Piotr
P
Ponikowski
University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
John R
JR
Teerlink
University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Adriaan A
AA
Voors
Momentum Research, Inc., 3100 Tower Boulevard, Suite 802, Durham, NC, 27707, USA.
Gad
G
Cotter
D000208:Acute Disease; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use*; D004487:Edema / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000453:epidemiology; D012720:Severity of Illness Index; D014970:Xanthines / Q000627:therapeutic use*
D004232:Diuretics; D014970:Xanthines; C073525:rolofylline
Acute heart failure; Global variation; Length of stay; Outcomes; Prognosis; Regional differences