Predictors and Associations With Outcomes of Length of Hospital Stay in Patients With Acute Heart Failure: Results From VERITAS

Abstract

Background: The length of hospital stay (LOS) is important in patients admitted for acute heart failure (AHF) as it prolongs an unpleasant experience for the patients and adds substantially to health care costs. Methods and Results: We examined the association between LOS and baseline characteristics, 10-day post-discharge HF readmission, and 90-day postdischarge mortality in 1,347 patients with AHF enrolled in the VERITAS program. Longer LOS was associated with greater HF severity and disease burden at baseline; however, most of the variability of LOS could not be explained by these factors. LOS was not associated with readmissions during the first days after discharge. However, LOS was a significant predictor of 90-day mortality (Hazard ratio for 1 day increase: 1.05; 95% C.I. 1.02, 1.07, p=0.00004), although the association is partially explained by concurrent end organ damage and worsening heart failure (WHF) during the first days of admission. Conclusions: In patients who have been admitted for Acute HF; longer length of hospital stay is associated with a higher rate of short-term mortality. Clinical Trial Registration: VERITAS-1 and -2:Clinicaltrials.gov identifiers NCT00525707 and NCT00524433. https://clinicaltrials.gov/ct2/results?term=NCT00525707&Search=Search

Patient journey after admission for acute heart failure: length of stay, 30‐day readmission and 90‐day mortality

“…The study was of relatively modest size and conducted in selected centres, and these results should be examined in larger prospective and possibly less selective patient populations. However, these results are supported by similar findings from the smaller VERITAS study …”

“…Again, these associations suggest that, to a certain degree, a dissociation exists in AHF between early readmission, and especially those for HF and death. The present data as well as similar analysis of VERITAS suggest that severity of HF and more complicated hospital course are major drivers of post‐discharge early mortality while early HF readmissions are driven by severity of disease but possibly more so by a tendency of the patients to be repeatedly readmitted. If confirmed, this finding may have significant implications for targeting therapy (i.e.…”

“…However, these results are supported by similar findings from the smaller VERITAS study. 20 For patients discharged alive after an admission for AHF, the main factors that are of importance to the patient and the healthcare system as a whole are the length of initial hospital stay, early readmission, and death after discharge. The present analysis suggests that although HF and renal impairment contribute to prolonged LOS as well as increased rate of early readmission and death, other factors may contribute to LOS and tendency for early readmission while early mortality is mostly driven by severity of disease and comorbidities.…”

Understanding worsening heart failure as a therapeutic target: another step forward?

“…In‐hospital length of stay (LoS) is clinically meaningful and closely associated with health care expenditure, and has been related to post‐discharge outcomes . However, its large variability across geographical areas makes it less suitable as a parameter in drug assessments in multicentre clinical trials …”

Acute heart failure: lessons learned, roads ahead

“…Length of stay in the hospital for patients with acute heart failure is much shorter in the United States compared to Europe, and it is much longer in Japan . These differences in length of hospitalization across geographically diverse study centres affect post‐discharge outcomes, primarily early rehospitalization rates, and it can confound the interpretation of clinical trial results …”