Background: Length of stay (LOS) during heart failure (HF) hospitalizations has decreased, accompanied by recent increases in post-discharge mortality and 30-day readmission rates among these patients.
Methods: We conducted a retrospective cohort study of 19,477 Medicare beneficiaries in order to determine whether patients with the longest LOS also had the highest risk of death or readmission. We included patients hospitalized for HF and discharged alive between 2007 and 2011 with documented left ventricular (LV) systolic, diastolic, or combined dysfunction. We estimated the associations of LOS, risk for 30-day mortality, and risk for 30-day readmission with: type of LV dysfunction, HF severity, comorbidity burden, discharge disposition, demographics, nursing home residence, and calendar year. Gamma regression, Poisson regression, and Cox proportional hazards were used to model LOS, 30-day mortality, and 30-day readmission, respectively. Each model included all covariates.
Results: The mean (IQR) LOS was 5 (4 - 8) days, 7% of the patients died within 30 days, and 23% of the patients were readmitted within 30 days. Patients with isolated diastolic dysfunction (DD) had 2% shorter LOS than patients with any systolic dysfunction (SD), but had 10% lower 30-day mortality. Comorbidities were associated with a 3% to 10% longer LOS, with the exception of chronic kidney disease (CKD) (16% longer) and malnutrition (30% longer). Only CKD, malnutrition, and chronic obstructive pulmonary disease (COPD) were associated with 30-day mortality (22%, 51%, and 14% higher risk, respectively). Most comorbidities were associated with 10% - 20% higher risk of 30-day readmission. Regarding discharge disposition, patients discharged home had 40% shorter LOS, 78% lower 30-day mortality, and 11% lower risk for 30-day readmission than patients discharged to a skilled nursing facility (SNF).
Conclusions: We found no mismatch between LOS and prognosis among Medicare beneficiaries hospitalized for HF.