The Impact Of Acute Heart Failure Related Length Of Stay On The 30-day All-Cause Readmission Rate.

Abstract

Background The length of hospital stay and 30-day all-cause readmission rate are key hospital performance metrics in acute heart failure (AHF) care. While a tremendous amount of resources is being dedicated to improving both metrics, the impact AHF related hospital length of stay on the 30-day all-cause readmission rate remains unstudied in the United States population. OBJECTIVE: The primary objective of the study was to evaluate the impact of hospital length of stay (LOS) for acute heart failure (AHF) related admissions on the 30-day all-cause readmission rate. Method A retrospective study was performed using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2018. We collected data on hospital readmissions for adults who were hospitalized for AHF and discharged. The primary outcome was the impact of AHF length of hospital stay on the 30-days all-cause readmission rates. Secondary outcomes were independent predictors of 30-day all-cause readmission, and resource use (total hospitalization costs). LOS was subdivided into LOS1(1-2 days), LOS2(3-5 days), and LOS3 (6 days and above), and the readmission rates were determined for each subgroup. Univariate and multivariate regression analysis using the Cox proportional hazard model was used to evaluate the impact of LOS on the 30-day all-cause readmission rate and to identify independent predictors for 30-day all-cause readmission. Results A cohort of 98,502 index AHF admissions were identified with 45.8% females and mean age of 69.3 years. The average LOS in the index AHF admission cohort was 5.57 days with a 30-day all-cause readmission rate of 16.7%. A total of 94,942 hospital days were associated with readmission, and the total health care in-hospital economic burden was $1.3 billion (in charges). There were 24632, 41874, 31996 admissions in the LOS1, LOS2 and LOS3 subcategories respectively. On multivariate analysis, the LOS subcategory did not significantly impact the 30-day all-cause readmission rates in the index AHF related hospital admission (LOS1; hazard ratio[HR]: 0.952; 95% confidence interval[CI]: 0.88 - 1.20; p=0.211, LOS 2; HR: 0.947; CI: 0.89 - 1.01; p=0.08, LOS 3; HR: 1.06; CI: 0.99 - 1.12; p=0.08]. The independent predictors for readmission identified were aortic stenosis (HR: 1.25; CI: 1.14- 1.37; P= < 0.0001), chronic obstructive pulmonary disease (COPD) (HR: 1.14; CI: 1.07- 1.20; P= < 0.0001), baseline chronic kidney disease (CKD)(HR: 1.14; CI: 1.06- 1.24; p=0.001), and leaving the hospital against medical advice (AMA) (HR: 2.09; CI- 1.83- 2.39; p = < 0.0001). Conclusion The LOS for AHF-related admission did not significantly impact the 30-day all-cause readmission rates. The independent predictors of the 30-day all-cause readmission rate were leaving AMA, baseline COPD, CKD, and aortic stenosis. The length of hospital stay and 30-day all-cause readmission rate are key hospital performance metrics in acute heart failure (AHF) care. While a tremendous amount of resources is being dedicated to improving both metrics, the impact AHF related hospital length of stay on the 30-day all-cause readmission rate remains unstudied in the United States population. OBJECTIVE: The primary objective of the study was to evaluate the impact of hospital length of stay (LOS) for acute heart failure (AHF) related admissions on the 30-day all-cause readmission rate. A retrospective study was performed using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2018. We collected data on hospital readmissions for adults who were hospitalized for AHF and discharged. The primary outcome was the impact of AHF length of hospital stay on the 30-days all-cause readmission rates. Secondary outcomes were independent predictors of 30-day all-cause readmission, and resource use (total hospitalization costs). LOS was subdivided into LOS1(1-2 days), LOS2(3-5 days), and LOS3 (6 days and above), and the readmission rates were determined for each subgroup. Univariate and multivariate regression analysis using the Cox proportional hazard model was used to evaluate the impact of LOS on the 30-day all-cause readmission rate and to identify independent predictors for 30-day all-cause readmission. A cohort of 98,502 index AHF admissions were identified with 45.8% females and mean age of 69.3 years. The average LOS in the index AHF admission cohort was 5.57 days with a 30-day all-cause readmission rate of 16.7%. A total of 94,942 hospital days were associated with readmission, and the total health care in-hospital economic burden was $1.3 billion (in charges). There were 24632, 41874, 31996 admissions in the LOS1, LOS2 and LOS3 subcategories respectively. On multivariate analysis, the LOS subcategory did not significantly impact the 30-day all-cause readmission rates in the index AHF related hospital admission (LOS1; hazard ratio[HR]: 0.952; 95% confidence interval[CI]: 0.88 - 1.20; p=0.211, LOS 2; HR: 0.947; CI: 0.89 - 1.01; p=0.08, LOS 3; HR: 1.06; CI: 0.99 - 1.12; p=0.08]. The independent predictors for readmission identified were aortic stenosis (HR: 1.25; CI: 1.14- 1.37; P= < 0.0001), chronic obstructive pulmonary disease (COPD) (HR: 1.14; CI: 1.07- 1.20; P= < 0.0001), baseline chronic kidney disease (CKD)(HR: 1.14; CI: 1.06- 1.24; p=0.001), and leaving the hospital against medical advice (AMA) (HR: 2.09; CI- 1.83- 2.39; p = < 0.0001). The LOS for AHF-related admission did not significantly impact the 30-day all-cause readmission rates. The independent predictors of the 30-day all-cause readmission rate were leaving AMA, baseline COPD, CKD, and aortic stenosis.