Which factors are associated with length of stay in older patients with acute decompensated heart failure with preserved ejection fraction?: AURORA study

Abstract

Aim In heart failure with preserved ejection fraction (HFpEF), it is unclear which factors on admission are correlated with long stays. In contrast, acute decompensated heart failure (ADHF) in older patients is associated with a high risk of a long stay. To manage older ADHF patients with HFpEF, it is important to reveal the risk factors for a long stay on admission. Methods We enrolled consecutive older patients (aged >75 years) with HFpEF (ejection fraction ≥50%) who were admitted to control ADHF from May 2014 to April 2016 using the acute heart failure registry in Osaka Rosai Hospital. We compared various factors, including age; sex; body mass index; heart rate; systolic blood pressure (SBP); atrial fibrillation; atherosclerotic risk factors, including dyslipidemia, diabetes mellitus, hypertension, smoking and chronic kidney disease; laboratory data, including brain natriuretic peptide and albumin; and medications, including loop diuretics, on pre‐admission between short‐stay (<14 days) and long‐stay groups. Results The long‐stay group consisted of 122 patients (59.5%). Multivariate analysis showed that male sex, SBP and albumin were independent predictors for long stays. According to the classification and regression tree and receiving operating characteristic curve analysis, all three factors on admission, including male sex, relatively low SBP (<155 mmHg) and hypoalbuminemia (<3.4 g/dL) could well predict the patients that would require long stays (area under curve 0.738). Conclusions Among older ADHF patients with HFpEF, male patients with relatively low SBP and hypoalbuminemia on admission should initially undergo more intensive management to reduce the length of stay. Geriatr Gerontol Int 2019; 19: 1084–1087.

Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure

“…For this reason, several nutritional assessment tools in hospitalized patients with heart failure had incorporated serum albumin in their patient evaluation [ 58 , 59 ]. In terms of LOS, one study in Japan reported that hypoalbuminemia was associated with prolonged LOS [ 21 ], which was in accordance with our results. However, only patients with HFpEF were included in that study, whereas our study included a broader spectrum of patients with heart failure.…”

“…Previously, several studies had identified other predictors of prolonged LOS in patients with heart failure such as gender [ 8 , 21 ], a number of comorbidities [ 9 ], severity of disease [ 9 ], and low systolic blood pressure (< 155 mmHg) on admission [ 21 ]. Almost all potential predictors included in our study showed statistical significance in univariable analysis, except for the male gender.…”

“…We explored thirteen candidate predictors for their contributions to the total LOS. All pre-selected risk factors and their cutoffs were chosen based on previous studies which addressed their association with prolonged LOS or mortality: age > 65 years [ 20 ], male gender [ 21 ], chronic kidney disease [ 10 ], ischemic heart disease [ 10 ], diabetes mellitus [ 10 ], atrial fibrillation [ 22 ], NYHA functional class III/IV [ 8 ], systolic blood pressure < 100 or > 140 [ 23 ], respiratory rate > 24 per minute [ 24 ], ProBNP ≥ 1800 pg/mL [ 17 ], serum sodium < 135 mmol/L [ 25 ], hemoglobin < 10 g/dL [ 26 ], and serum albumin < 3.5 g/dL [ 21 ].…”

Some comments for better understanding of the study entitled “Which factors are associated with length of stay in older patients with acute decompensated heart failure with preserved ejection function?: AURORA study”

“…We have read with great interest the article by Nishino et al 1 The authors aimed to reveal the risk factors associated with long hospital stays in patients with heart failure (HF) with preserved ejection fraction who were admitted to hospital with acute decompensated HF. They compared the baseline characteristics of the short-and long-stay groups.…”

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COMMENTSSome comments for better understanding of the study entitled "Which factors are associated with length of stay in older patients with acute decompensated heart failure with preserved ejection function? : AURORA study"Dear Editor,We have read with great interest the article by Nishino et al 1 The authors aimed to reveal the risk factors associated with long hospital stays in patients with heart failure (HF) with preserved ejection fraction who were admitted to hospital with acute decompensated HF. They compared the baseline characteristics of the short-and long-stay groups.

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