Abstract 12794: Hospital Length of Stay and Readmissions Post Heart Failure Hospitalization in the EVEREST Trial

Abstract

Background: Previous reports have provided conflicting data regarding the relationship between length of stay (LOS) and subsequent readmissions risk among patients hospitalized for heart failure (HF). Methods: We performed a post-hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial to evaluate the differences in LOS overall and between geographical regions (North America, South America, Western Europe, and Eastern Europe) in association with all-cause and cause specific (HF, cardiovascular [CV] non-HF and non-CV) readmissions within 30 days of discharge after HF hospitalization. Results: The median (IQR) LOS among the 4,133 patients enrolled from 20 countries across 359 sites was 8 (4-11) days. The 30-day readmissions rates were 15.6% (95% confidence intervals [CI] 14.6-16.8) for all-cause; 5.5% (95%CI 4.9-6.3) for HF; 4.4% (95%CI 3.8-5.1) for CV non-HF and 5.8% (95%CI 5.1-6.6) for non-CV readmissions. Overall there was a positive correlation between LOS and all cause readmissions (r=0.09; 95%CI 0.06-0.12). The adjusted odds ratio for the top (>14 days) versus the bottom (<3 days) quintile for LOS was 1.39 (95%CI 0. 92-2.11) for all-cause; 0.43 (95%CI 0.24-0.79) for HF; 2.99 (95%CI 1.49-6.02) for CV non-HF and 1.72 (95%CI 1.05-2.81) for non-CV readmissions, Figure 1. These findings remained consistent in analyses within patient characteristic subgroups and also largely within regions. Conclusions: Longer hospital LOS was associated with a higher risk for all-cause, CV non-HF, and non-CV readmissions, and with a lower risk of HF readmissions. These results may have important bearing in developing clinical and research strategies to reduce readmissions.