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Comparative Study
. 2016 Jul 1;118(1):79-85.
doi: 10.1016/j.amjcard.2016.04.015. Epub 2016 Apr 21.

Comparison of Length of Stay, 30-Day Mortality, and 30-Day Readmission Rates in Medicare Patients With Heart Failure and With Reduced Versus Preserved Ejection Fraction

Matthew Shane Loop  1 , Melissa K Van Dyke  2 , Ligong Chen  3 , Todd M Brown  4 , Raegan W Durant  5 , Monika M Safford  6 , Emily B Levitan  3
Affiliations
Comparative Study

Comparison of Length of Stay, 30-Day Mortality, and 30-Day Readmission Rates in Medicare Patients With Heart Failure and With Reduced Versus Preserved Ejection Fraction

Matthew Shane Loop et al. Am J Cardiol. .

Abstract

Length of stay (LOS), 30-day mortality, and 30-day readmission rates have not been compared between Medicare beneficiaries with heart failure (HF) with reduced ejection fraction (HFrEF) and beneficiaries with heart failure with preserved ejection fraction (HFpEF), although HFpEF is common in patients with HF. To determine whether type of HF (HFrEF or HFpEF) was associated with LOS, 30-day mortality, and 30-day readmission, we used a cohort of 19,477 Medicare beneficiaries admitted to the hospital and discharged alive with a primary discharge diagnosis of HF between 2007 and 2011. Gamma regression, Poisson regression, and Cox proportional hazards with a competing risk for death were used to model LOS, 30-day mortality, and 30-day readmission rate, respectively. All models were adjusted for HF severity, co-morbidities, demographics, nursing home residence, and calendar year of admission. Beneficiaries with HFpEF had an LOS 0.02 days shorter than beneficiaries with HFrEF and a nearly identical 30-day readmission rate. Thirty-day mortality was 10% lower in beneficiaries with HFpEF versus HFrEF. In conclusion, readmission rates were as high in those with HFpEF as they are in those with HFrEF, with comparable LOS in the hospital.

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Figures

Figure 1
Figure 1. Histogram of length of stay (LOS) for study sample by heart failure type
Histogram shows extreme right-skewness of LOS, as well as the similar distribution of LOS between those with heart failure with preserved ejection fraction (HFpEF) and those with heart failure with reduced ejection fraction (HFrEF). For display purposes, sample was restricted to beneficiaries with LOS < 30 days.
Figure 2
Figure 2. Cumulative incidence functions for death and rehospitalization for any cause during the first 30 days after discharge from a heart failure hospitalization, separated by heart failure type
Thirty-day mortality is slightly higher in those with heart failure with reduced ejection fraction (HFrEF) compared to those with heart failure with preserved ejection fraction (HFpEF). Thirty-day readmission rates are similar between those with HFpEF and those with HFrEF.
Figure 3
Figure 3. Ratios of LOS for heart failure type and covariates
Parameter estimates include likelihood ratio 95% confidence intervals. Ratio of 1 indicates no association. CCI (Charlson Comorbidity Index); CHD (Coronary Heart Disease); CKD (Chronic Kidney Disease); COPD (Chronic Obstructive Pulmonary Disease); CRTD (Cardiac Resynchronization Therapy – Defibrillator); CRTP (Cardiac Resynchronization Therapy – Pacemaker); HFpEF (Heart Failure with Preserved Ejection Fraction); HFrEF (Heart Failure with Reduced Ejection Fraction); ICU (Intensive Care Unit)
Figure 4
Figure 4. Risk ratios for 30-day all-cause mortality for heart failure type and covariates
Parameter estimates include likelihood ratio 95% confidence intervals. Risk ratio of 1 indicates no association. CCI (Charlson Comorbidity Index); CHD (Coronary Heart Disease); CKD (Chronic Kidney Disease); COPD (Chronic Obstructive Pulmonary Disease); CRTD (Cardiac Resynchronization Therapy – Defibrillator); CRTP (Cardiac Resynchronization Therapy – Pacemaker); HFpEF (Heart Failure with Preserved Ejection Fraction); HFrEF (Heart Failure with Reduced Ejection Fraction); ICU (Intensive Care Unit)
Figure 5
Figure 5. Risk ratios for 30-day hospital readmission for heart failure type and covariates
Parameter estimates include likelihood ratio 95% confidence intervals. Risk ratio of 1 indicates no association. CCI (Charlson Comorbidity Index); CHD (Coronary Heart Disease); CKD (Chronic Kidney Disease); COPD (Chronic Obstructive Pulmonary Disease); CRTD (Cardiac Resynchronization Therapy – Defibrillator); CRTP (Cardiac Resynchronization Therapy – Pacemaker); HFpEF (Heart Failure with Preserved Ejection Fraction); HFrEF (Heart Failure with Reduced Ejection Fraction); ICU (Intensive Care Unit)
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References

    1. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–259. - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147–e239. - PubMed
    1. Sweitzer NK, Lopatin M, Yancy CW, Mills RM, Stevenson LW. Comparison of clinical features and outcomes of patients hospitalized with heart failure and normal ejection fraction (> or =55%) versus those with mildly reduced (40% to 55%) and moderately to severely reduced (<40%) fractions. Am J Cardiol. 2008;101:1151–1156. - PMC - PubMed
    1. Whellan DJ, Zhao X, Hernandez AF, Liang L, Peterson ED, Bhatt DL, Heidenreich PA, Schwamm LH, Fonarow GC. Predictors of hospital length of stay in heart failure: findings from Get With the Guidelines. J Card Fail. 2011;17:649–656. - PubMed
    1. Nichols GA, Reynolds K, Kimes TM, Rosales AG, Chan WW. Comparison of Risk of Rehospitalization, All-Cause Mortality, and Medical Care Resource Utilization in Patients With Heart Failure and Preserved Versus Reduced Ejection Fraction. Am J Cardiol. 2015;116:1088–1092. - PubMed

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