Right ventricular dysfunction but not left ventricular ejection fraction is associated with length of stay in acute heart failure

Abstract

Abstract Background Acute heart failure (AHF) remains a substantial healthcare burden worldwide. It is therefore important to identify triaging markers which are associated with length of stay (LOS). Attention from an echocardiographic perspective often centres on the left-ventricular ejection fraction (LVEF). The role of right ventricular (RV) function and pulmonary hypertension (PHT) remains less certain. Methods We investigated LOS in 440 consecutive patients presenting in AHF. We also identified those admitted ≥5 days – the cut-off date when reimbursement for AHF-related hospital care is reduced significantly in England. All patients underwent bedside echocardiography within 24 hours of recruitment, prior to intensive diuresis. Patients were followed up for 2 years. We analysed the association between echo parameters with LOS in 414 patients who survived to discharge. We also compared those admitted ≥5 and <5 days. Results The average LOS for survivors was 7.7±5.7 days; 216 (52.2%) stayed ≥5 days, with 198 (47.8%) discharged <5 days. LVEF was not correlated with LOS; Spearman's ρ −0.062 (p=0.207). RV fractional area change (ρ −0.108 [p<0.03]), tricuspid annulus plane systolic plane excursion (ρ −0.166 [p<0.001]) and systolic pulmonary artery pressure (ρ −0.161 [p<0.001]) were all correlated with LOS. In patients with longer LOS, greater BNP, diabetes and chronic kidney disease were more prevalent. 2-year all-cause mortality was 41.0% in those admitted ≥5 days and 27.1% for <5 days (Hazard ratio 1.57; 95% CI 1.13–2.19 [p=0.007]). Discussion RV dysfunction and severe PHT, not LVEF, were correlated with increased LOS in 414 consecutive patients discharged from an admission with AHF. These patients will place a disproportionate cost on health care resources. These hypothesis generating results suggest early echo assessment to quantify RV dysfunction may help to risk stratify patients with AHF and re-design hospital tariffs. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Abbott Laboratories Table and KM curve