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Observational Study
. 2018 Jan 31;7(3):e007944.
doi: 10.1161/JAHA.117.007944.

Outcomes of Heart Failure Admissions Under Observation Versus Short Inpatient Stay

Ahmad Masri  1 , Andrew D Althouse  1 , Jeffrey McKibben  1   2 , Floyd Thoma  1 , Michael Mathier  1 , Ravi Ramani  1 , Jeffrey Teuteberg  3 , Oscar Marroquin  1   2 , Joon S Lee  1 , Suresh R Mulukutla  4   5
Affiliations
Observational Study

Outcomes of Heart Failure Admissions Under Observation Versus Short Inpatient Stay

Ahmad Masri et al. J Am Heart Assoc. .

Abstract

Background: Patients with heart failure (HF) are admitted either under observation (OBS) or inpatient stays; however, there is little data on whether this designation reflects the clinical status of a patient, with significant logistical and financial implications. We sought to compare the outcomes of patients with HF admitted OBS versus inpatient stay (≤2 days; INPT).

Methods and results: From January 1, 2008 to September 30, 2015, our multisite health system saw 21 339 unique patients totaling 52 493 hospital admissions with a primary diagnosis of HF. Patients were excluded if they underwent cardiac surgery (n=611), heart transplantation (n=187), or left ventricular assist device insertion (n=198), or if they died during hospitalization (n=1839). Of the remaining 50 654 discharges, 2 groups were identified: INPT group and OBS group. Outcomes were HF readmission, all-cause readmission, and all-cause mortality within 1 year of discharge. Hazard ratios were computed using the Andersen-Gill method in the Cox proportional-hazards model. A total of 8709 admissions (17%) occurred in the INPT group and 2648 admissions (5%) occurred in the OBS group. HF readmission rate at 1 year was 55.3% in INPT versus 66.5% in OBS (hazard ratio, 0.75; 95% confidence interval, 0.71-0.80; P<0.01). All-cause readmission rate at 1 year was 70.7% in INPT versus 82.5% in OBS (hazard ratio, 0.74; 95% confidence interval, 0.70-0.78; P<0.01). All-cause mortality at 1 year occurred in 25.2% of INPT versus 24.2% of OBS (hazard ratio, 1.03; 95% confidence interval, 0.95-1.12; P=0.46).

Conclusions: HF admissions designated INPTs were associated with lower readmission rates and equivalent mortality to those designated OBS.

Keywords: admission under observation; death; health policy; heart failure; outcomes research; readmission.

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Figures

Figure 1
Figure 1
Histogram of length of stay (LOS) for the overall study population (live discharges without left ventricular assist device insertion, heart transplantation, or major cardiac surgical procedures).
Figure 2
Figure 2
Temporal distribution of each patient's encounter under observation vs inpatient stay from January 1, 2008 through September 30, 2015.
Figure 3
Figure 3
Outcomes of patients admitted under observation (OBS) vs inpatient stay and discharged in ≤2 days (1–2). A, Freedom from heart failure readmission. B, Freedom from readmission for a cardiac cause. C, Freedom from readmission for any cause. D, Freedom from mortality.
See this image and copyright information in PMC

Comment in

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