The 30‐day metric in acute heart failure revisited: data from IN‐HF Outcome, an Italian nationwide cardiology registry

Abstract

Aims Unplanned readmissions early after a discharge from acute heart failure hospitalization are common and have become a reimbursement benchmark and marker of hospital quality. However, the competing risk of short‐term post‐discharge mortality is substantial. Methods and results Using data from the prospective, nationwide Registry IN‐HF Outcome, we analysed the incidence and predictors of 30‐day mortality or readmissions and associated days‐alive‐out‐of‐hospital (DAOH) in 1520 patients discharged alive after admission for acute heart failure. Within 30 days after discharge, 94 patients (6.2%) were readmitted (91% for cardiovascular causes; 60% recurrent heart failure) and 42 (2.8%) died, 10 of which occurred during readmission. Overall, 126 patients (8.3%) met the combined endpoint. By multivariable logistic regression, worsening chronic heart failure as clinical presentation [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.21–2.77, P = 0.005), inotropes during admission (OR 2.19, 95% CI 1.40–3.43, P = 0.0006), length of stay (OR 1.02, 95% CI 1.01–1.04, P = 0.002) and renin–angiotensin system inhibitors at discharge (OR 0.52, 95%CI 0.35–0.77, P = 0.001) independently predicted 30‐day all‐cause mortality and/or readmission (c‐statistic = 0.695). Per cent 30‐day DAOH was lower in patients with in‐hospital inotrope use, no renin–angiotensin system inhibitors prescription at discharge, New York Heart Association III–IV class at discharge, and correlated inversely with length of stay and age. Conclusion A clinical and biohumoral profile consistent with chronic advanced heart failure and end‐organ damage identifies acute heart failure patients discharged home from cardiology units, who are at highest risk of early death and/or readmission. These findings have practical implications for tailoring specific follow‐up.

Clinical characteristic of 100 patients from pilot registry of heart failure patients hospitalized in the district hospital in Poland

“…As in most European registries, such as ESC-HF Pilot [7], EHFS II [8], IN-HF [9], also in our study the majority of hospitalized patients (63%) were males. Women are traditionally less represented, not only in randomized clinical trials on HF but also in hospital registries.…”

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

“…The length of the initial hospital stay has been difficult to analyse because of its extreme variation among geographical regions . Indeed, in the present analysis, LOS varied between 5 and 6 days in Argentina, Israel and the USA to 17 days in Russia.…”

“…The patient journey after being admitted encompasses several important possible outcomes including a long length of stay (LOS) during the initial hospitalization, followed by a high risk for repeat readmissions [most of which are for heart failure (HF)] and an increased risk of death . Although all of these outcomes have been examined as measures of treatment success and, in some jurisdictions suggested as surrogate measures of hospital performance, they tend to vary substantially, especially among countries and geographical regions, and tools to influence these outcomes globally are missing. This is especially true for LOS, where uncertainty surrounds what constitutes the optimal LOS, given that some studies suggest that short LOS may be associated with a higher rate of readmission or even death .…”

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

“…The relationship between hospital length-of-stay (LOS) and post-discharge outcomes is of considerable interest. Although LOS has recently been suggested as a surrogate measure of hospital performance (3), LOS varies widely between countries and geographic regions (4)(5)(6)(7), and neither studies nor guidelines provide criteria for determining the optimal LOS for patients. This absence of recommendation is driven by the paucity of data examining determinants of LOS and its relationship with outcomes after discharge.…”