Risk Factors for In-Hospital Mortality in Heart Failure Patients: Does Rurality, Payer or Admission Source Matter?
OBJECTIVE
Considering the high prevalence of heart failure and the economic burden of the disease, factors that influence in-hospital mortality are of importance in improving outcomes of care for this patient population. The purpose of this study was to examine the determinants of in-hospital mortality for adult heart failure patients.


METHODS
The study design is a retrospective observational study design using the 2010 Nebraska Hospital Discharge data set including 4,319 hospitalizations for 3,521 heart failure patients admitted to 79 hospitals in Nebraska. Hierarchical logistic regression models including patient- and hospital-specific random intercepts were analyzed. Covariates included in the analysis were patient age in years, gender, comorbidity status, length of stay, primary payer, type and source of admission, transfers, and rurality of county of residence.


RESULTS
Overall, 3.5% of heart failure patients died during their hospital stay. In logistic regression analysis that adjusted for age, sex, and comorbidities, the odds of dying in hospital for heart failure patients increased with age (OR = 1.03, 95% CI: 1.01-1.04), co-morbidity (OR = 1.15; 95% CI: 1.05-1.25) and length of stay (OR = 1.03, 95% CI: 1.01-1.05). The patient's gender, payer source, rurality of county of residence, source, and type of admission were not risk factors for in-hospital death.


CONCLUSIONS
Increasing age, comorbidity and length of stay were risk factors for in-hospital death for heart failure. An understanding of the risk factors for in-hospital death is critical to improving outcomes of care for heart failure patients.
Department of Health Services Research & Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Preethy
P
Nayar
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Fang
F
Yu
Department of Health Services Research & Administration, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
Aastha
A
Chandak
Department of Environmental and Occupational Health, University of Nevada, Las Vegas, Nevada.
Ge Lin
GL
Kan
Division of Cardiology, Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
Brian
B
Lowes
Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia.
Bettye A
BA
Apenteng
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009329:Nebraska; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*
health services research; hospitals; medical care