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Multicenter Study
. 2019 Dec:70:24-32.
doi: 10.1016/j.ejim.2019.08.007. Epub 2019 Aug 23.

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

Òscar Miró  1 , Joan Padrosa  2 , Koji Takagi  3 , Étienne Gayat  3 , Víctor Gil  2 , Pere Llorens  4 , Francisco Javier Martín-Sánchez  5 , Pablo Herrero-Puente  6 , Javier Jacob  7 , María Mir Montero  8 , Josep Tost  9 , María Pilar López Díez  10 , Lissete Traveria  11 , Raquel Torres-Gárate  12 , María Isabel Alonso  13 , Carmen Agüera  14 , Amparo Valero  15 , Patricia Javaloyes  4 , W Frank Peacock  16 , Héctor Bueno  17 , Alexandre Mebazaa  18 ; ICA-SEMES Research Group; Marta Fuentes  19 , Cristina Gil  19 , Héctor Alonso  20 , Pablo Garmila  20 , Guillermo Llopis García  21 , María Cecilia Yáñez-Palma  21 , Sergio Iglesias López  21 , Rosa Escoda  22 , Carolina Xipell  22 , Carolina Sánchez  22 , Josep María Gaytan  22 , María José Pérez-Durá  23 , Eva Salvo  23 , José Pavón  24 , Antonio Noval  25 , José Manuel Torres  26 , María Luisa López-Grima  27 , Amparo Valero  27 , Marian Ángeles Juan  27 , Alfons Aguirre  28 , Julián Errasti Morales  28 , Silvia Mínguez Masó  28 , María Isabel Alonso  29 , Francisco Ruiz  29 , José Miguel Franco  30 , Ana Belén Mecina  31 , Josep Tost  32 , Susana Sánchez  33 , Virginia Carbajosa  33 , Pascual Piñera  34 , José Andrés Sánchez Nicolás  34 , Raquel Torres Garate  35 , Aitor Alquezar  36 , Miguel Alberto Rizzi  36 , Sergio Herrera  36 , Alex Roset  37 , Irene Cabello  37 , Fernando Richard  38 , José María Álvarez Pérez  38 , María Pilar López Diez  38 , Joaquín Vázquez Álvarez  39 , Belén Prieto García  39 , María García García yMarta Sánchez González  39 , Patricia Javaloyes  40 , Víctor Marquina  40 , Inmaculada Jiménez  40 , Néstor Hernández  40 , Benjamín Brouzet  40 , Sergio Ramos  40 , Ana López  40 , Juan Antonio Andueza  41 , Rodolfo Romero  42 , Martín Ruíz  43 , Roberto Calvache  43 , María Teresa Lorca  44 , Luis Calderón  44 , Beatriz Amores Arriaga  45 , Beatriz Sierra  45 , Enrique Martín Mojarro  46 , Lisette Travería Bécquer  47 , Guillermo Burillo  47 , Lluís Llauger García  48 , Gerard Corominas LaSalle  48 , Carmen Agüera Urbano  49 , Ana Belén García Soto  49 , Elisa Delgado Padial  49 , Ester Soy Ferrer  50 , Manuel Garrido  51 , Francisco Javier Lucas  52 , Rut Gaya  53 , Carlos Bibiano  54 , María Mir  54 , Beatriz Rodríguez  54 , Natalia Sánchez  54 , José Luis Carballo  55 , Esther Rodríguez-Adrada  56 , Belén Rodríguez  56
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Free article
Multicenter Study

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

Òscar Miró et al. Eur J Intern Med. 2019 Dec.
Free article

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.

Keywords: Acute heart failure; Length of hospitalisation; Mortality; Post-discharge outcomes; Readmission; Vulnerability phase.

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