Abstract
BackgroundHospital length of stay (LOS) is a key determinant of heart failure hospitalization costs. Longer LOS is associated with lower quality of care measures and higher rates of readmission and mortality. Right ventricular (RV) dysfunction predicted poor outcomes in patients with stable chronic heart failure (CHF), however, its prognostic value in the acute decompensated heart failure (ADHF) patients has not been sufficiently clarified. This study investigated the prognostic value of RV dysfunction in predicting longer LOS in ADHF patients.MethodsA prospective cohort study was conducted in National Cardiovascular Center Harapan Kita to all patients admitted with ADHF. Clinical data and baseline RV function assessed by tricuspid annular plane systolic excursion (TAPSE) were collected. Clinical comorbidities including malnutrition, pneumonia and worsening renal function (WRF) were monitored during hospitalization. The primary outcome was hospital LOS. Cox regression analysis was used to identify independent predictors for longer LOS.ResultsTwo hundred and fifty-nine ADHF patients were included in this cohort study. On time-to-event analysis, diastolic blood pressure (HR = 1.011; 95 % CI = 1.004-1.018; p = 0.002), hemoglobin levels (HR = 1.102; 95 % CI = 1.045-1.162; p < 0.001), RV function (HR = 0.659; 95 % CI = 0.506-0.857; p = 0.002), WRF (HR = 2.015; 95 % CI = 1.520-2.670; p < 0.001) and malnutrition (HR = 5.965; 95 % CI = 4.402-8.082; p < 0.001) were associated with longer LOS. In a multivariate Cox regression model, RV function (HR = 0.466; 95 % CI = 0.238-0.915; p = 0.026), WRF (HR = 2.985; 95 % CI = 2.032-4.386; p < 0.001) and malnutrition (HR = 7.479; 95 % CI = 5.071-11.030; p < 0.001) were the independent predictors of longer hospital LOS. Based on the median TAPSE values, patients with TAPSE ≤ 16 mm had significantly longer LOS (HR = 2.227; 95 % CI = 1.103-4.494; p = 0.026) compared to those with TAPSE > 16 mm.ConclusionsRight ventricular dysfunction, WRF and malnutrition are important predictors of longer LOS. This is the first study to describe that in ADHF patients, lower the TAPSE resulted in longer the LOS.
Highlights
Hospital length of stay (LOS) is a key determinant of heart failure hospitalization costs
Patients characteristics Of a total of 265 acute decompensated heart failure (ADHF) patients that were initially included in this prospective cohort study, 6 patients died during hospitalization period
The principal findings in this study are: 1) Right ventricular (RV) dysfunction as assessed by tricuspid annular plane systolic excursion (TAPSE) is an independent predictor of longer LOS, and 2) worsening renal function and malnutrition are associated significantly with longer LOS
Summary
Hospital length of stay (LOS) is a key determinant of heart failure hospitalization costs. Longer LOS is associated with lower quality of care measures and higher rates of readmission and mortality. Longer LOS is associated with lower performance on quality of care measures and higher rates of subsequent readmission and mortality [2, 5]. Several studies revealed that possible determinants of longer LOS for HF patients include socio-demographic variables, medical comorbidity, disease severity (worse functional class and lower left ventricular ejection fraction), clinical presentation, in-patient treatment, inhospital progress and the development of iatrogenic complications [1, 6,7,8]. Some medical comorbidities that were known in prolonging LOS are concurrent stroke, worsening renal function (WRF), atrial fibrillation, respiratory problems requiring specific treatment, and malnutrition [1, 8,9,10,11]
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