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

Abstract: 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.

 Fuente: European journal of internal medicine 2019 70, 24-32

 Editorial: Elsevier

 Año de publicación: 2019

 Nº de páginas: 9

 Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.ejim.2019.08.007

 ISSN: 0953-6205,1879-0828

 Url de la publicación: https://doi.org/10.1016/j.ejim.2019.08.007

Autoría

MIRÓ, ÒSCAR

PADROSA, JOAN

TAKAGI, KOJI

GAYAT, ÉTIENNE

GIL, VÍCTOR

LLORENS, PERE

MARTÍN-SÁNCHEZ, FRANCISCO JAVIER

HERRERO-PUENTE, PABLO

JACOB, JAVIER

MIR MONTERO, MARÍA

TOST, JOSEP

LÓPEZ DÍEZ, MARÍA PILAR

TRAVERIA, LISSETE

TORRES-GÁRATE, RAQUEL

ALONSO, MARÍA ISABEL

AGÜERA, CARMEN

VALERO, AMPARO

JAVALOYES, PATRICIA

PEACOCK, W. FRANK