Length of Stay and Readmission Rates in Pediatric Acute Heart Failure

Abstract

<h3>Purpose</h3> Establishing baseline metrics for pediatric acute heart failure (AHF) is critical for developing quality improvement (QI) metrics aimed at improving outcomes and resource utilization. Benchmark data from adult AHF demonstrate median length of stay (LOS) is 4 days and 30-day HF-related readmission (HFread) rate is 6%. Our pilot study aims to describe current pediatric AHF LOS and 30-day HFread. <h3>Methods</h3> A retrospective data analysis from 4 pediatric centers was performed from July 1, 2019 to June 30, 2020 among children hospitalized for AHF who survived hospitalization, including those who received were listed and underwent heart transplant and ventricular assist device implantation. Data collection included cardiac diagnosis, LOS, and 30-day HFread. Descriptive statistics were performed for analysis. <h3>Results</h3> A total of 120 patients with 179 AHF hospitalizations were analyzed from 4 pediatric HF centers. The median LOS was 13 days (IQR 4-40). Diagnoses with median LOS >13 days included dilated cardiomyopathy, restrictive cardiomyopathy, myocarditis, other congenital heart disease excluding failing Glenn and Fontan palliated CHD (Table). Thirty-day HFread was 20%. Diagnoses associated with 30-day HFread >20% included dilated cardiomyopathy, failing Fontan, and failing Glenn. <h3>Conclusion</h3> Based on this pilot study, children hospitalized with AHF have considerably longer hospital LOS and higher readmission rates compared to national benchmarks for adults hospitalized with AHF. Identifying risk factors for prolonged LOS and HFread can help direct future QI initiatives. Initial AHF QI projects should include clear communication of management goals during hospitalization and at discharge.