Abstract 11307: Association of Acute Heart Failure Length of Stay With Subsequent Re-Hospitalization and All-Cause Mortality Among Patients With Preserved vs. Reduced Ejection Fraction
Introduction: Length of stay (LOS) during acute heart failure (AHF) hospitalizations is associated with the risk of re-hospitalization and mortality.
Hypothesis: We explored whether the association of LOS, re-hospitalizations, and all-cause mortality (ACM) differed between patients with preserved (HFpEF) vs. reduced ejection fraction (HFrEF).
Methods: We identified members of Kaiser Permanente in the Northwest and Southern California regions who had an ejection fraction (EF) measured during an index AHF hospitalization and were discharged alive in 2008-2011 (n=6,524). After excluding 677 patients with borderline EF values (41-49%), we assessed the risk of re-hospitalization and mortality within 30 days and 1 year comparing patients with HFpEF (EF ≤50%) vs. HFrEF (EF <40%). We isolated the contribution of LOS using multivariable logistic regression models that included demographic and clinical characteristics, comorbidities, and selected pharmacotherapies.
Results: Patients were 53% male with mean age 74±13 years; 16% were African-American, 20% Hispanic and 57% White. Mean LOS of the index hospitalization was 3.9±3.7 days among HFpEF patients (62% of the sample) and 4.0±3.5 among HFrEF patients (38%). Re-hospitalization and ACM rates within 30 days and 1 year were similar between the two groups. Among both groups, each day of the index hospitalization was associated with an adjusted 3-4% risk of re-hospitalization within 30 days and a 2-3% risk within 1 year. Among HFpEF patients, each day of the index hospitalization was associated with a 7% risk of mortality within 30 days (1.07, 95% CI 1.04-1.09) and a 4% risk within 1 year (1.04, 1.03-1.05). In contrast, each day of the index hospitalization was associated with a 12% risk of mortality within 30 days (1.12, 95% CI 1.08-1.15) and an 8% risk within 1 year (1.08, 1.06-1.10) among HFrEF patients.
Conclusions: In this large diverse sample of patients hospitalized for AHF, longer LOS during the index hospitalization was significantly and similarly associated with an increased risk of re-hospitalization within 30 days and 1 year among HFpEF and HFrEF patients. However, each day of the index hospitalization conferred nearly twice the risk of mortality within 30 days and 1 year among HFrEF vs. HFpEF patients.
Author Disclosures: G.A. Nichols: Research Grant; Significant; Novartis Pharmaceuticals, Merck & Co, AstraZeneca, Bristol-Myers Squibb. K. Reynolds: Research Grant; Significant; Novartis Pharmaceuticals. M.G. Butler: Research Grant; Significant; Novartis Pharmaceuticals. T.M. Kimes: None. W.W. Chan: Employment; Significant; Novartis.
- © 2014 by American Heart Association, Inc.