If a patient is hospitalized for heart failure (HF), a short stay is associated with higher rates of cardiovascular and readmission and with lower rates of non-cardiovascular readmissions, according to a new study. Conversely, a long stay for HF is associated with increased rates of all types of readmissions and an increased risk of mortality.

The study was published in the August issue of the Journal of the American College of Cardiology.

The researchers—led by Maneesh Sud, MD, with the Institute for Clinical Evaluative Sciences University Health Network, Toronto General Hospital—stated they chose to analyze these associations because, even though reductions in readmissions and mortality rates are both healthcare priorities today, the ways in which HF-related length of stay (LOS) affects these outcomes is not well understood.

 “Nearly 20 percent of discharged patients are readmitted, thus resulting in costs exceeding $17 billion annually in the United States alone,” wrote Sud and colleagues. They also said that HF is a major cause of both hospitalization and readmission, with about 25 percent of HF patients being readmitted within 30 days.

A better understanding of factors useful for predicting greater risk of readmission may help advance the implementation of interventions in higher-risk patients, especially during periods of transitional care.

Between April 1, 2003, and March 31, 2012, the researchers conducted a population-based analysis of patients age 65 and older living in Ontario who were admitted to the hospital with HF as their primary diagnosis. In order to capture only acute presentations of HF, the researchers excluded hospitalizations in which the patients were not admitted directly from the emergency department (ED).

Ultimately, they analyzed data based upon 58,230 unique patients, all admitted from the ED, whose hospital stays ranged from 1 to 14 days.

 “The underlying reasons for the associations between LOS and readmissions and LOS and mortality are complex,” wrote Sud et al.

Patients with longer stays were older and had more non-cardiovascular comorbidities, such as diabetes.

The older patients’ comorbidities could increase their risk for complications, nosocomial infections and deconditioning, thereby contributing to higher rates of noncardiovascular readmissions and death, the authors wrote. Those patients with longer stays may also be the ones with the most severe cases of HF.

The authors called for continuing investigations of the associations between LOS and readmission and mortality risk so that targeted approaches can be devised to reduce those risks. Such targeted approaches might include prompt post-discharge follow up by physicians and improved transitional care.