Patient journey after admission for acute heart failure: length of stay, 30-day readmission and 90-day mortality
Open accessAbstract
Aims: The course of patients following admission for acute heart failure (AHF) is of major importance to patients and healthcare providers. We examined predictors and associations of length of stay (LOS), 30-day post-discharge readmission and 90-day post-discharge mortality in 1990 patients enrolled in the PROTECT study. Methods and results: PROTECT was a randomized study that examined the effect of the adenosine blocker rolofylline in patients within 24 h of admission for AHF with mild to moderate renal impairment. Geographic-region-adjusted multivariable models showed that LOS was only partly explained by the severity of heart failure (HF), comorbidities (diabetes mellitus, renal impairment, ischaemic heart disease) and degree of metabolic dysfunction (cholesterol and albumin) at baseline (adjusted R2 0.27). Addition of in-hospital worsening heart failure (WHF) and changes in metabolic markers contributed significantly to prediction of LOS [R2 difference 0.050, 95% confidence interval (CI) 0.0282–0.072]. Thirty-day HF readmission was associated with more severe HF and previous HF admission but not with LOS (odds ratios 1.00, 95% CI 0.97–1.04). Death within 90 days after discharge was associated with older age, more severe HF, worse renal function, and lower sodium and bicarbonate at admission; LOS was a strong predictor of 90-day post-discharge mortality. Conclusions: In patients admitted for AHF, LOS is not well-predicted by traditional markers of disease severity, but strongly associated with the occurrence of in-hospital WHF. Longer LOS is a strong predictor of early mortality after discharge but not of readmission. These findings may help focus efforts to reduce LOS and post-discharge outcomes on patients’ subgroups at increased risk.
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The 3-month timeframe is clinically and operationally significant as the hospital's diabetes case manager follows up on discharged patients during this period, frequently identified as the high-risk period in the literature.
“The 3-month timeframe is clinically and operationally significant as the hospital’s diabetes case manager follows up on discharged patients during this period, frequently identified as the high-risk period in the literature [39–41].”
From Machine learning-driven risk prediction for post-hospitalization diabetes case management: Integrating clinical and social determinants of health (2026) · cites this paper as [40]
The Results sections report readmissions within 30 days and deaths within 90 days after discharge among patients hospitalized for acute heart failure. This supports the relevance of early post-discharge risk, but the paper does not identify the full three-month period as high-risk for discharged diabetes patients. The hospital’s case-manager follow-up is the citing authors’ own context, not a finding attributed to this source. (LLM, conf=0.83)
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Lee, S.-Y., Saleem, M., Land, A. M., DeLaney, E. W., Garretson, A. R., Patel, M., Hall, A. G., Westrick, S., Ovalle, F., Cherrington, A. L., et al. (2026) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2026.106604
- Authors
- Davison, B. A., Metra, M., Senger, S., Edwards, C., Milo, O., Bloomfield, D. M., Cleland, J. G., Dittrich, H. C., Givertz, M. M., O’Connor, C. M., Massie, B. M., Ponikowski, P., Teerlink, J. R., Voors, A. A., & Cotter, G.
- Affiliations
- Momentum Research (US)
- University of Brescia (IT)
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- University of Hull (GB)
- University of Iowa (US)
- Brigham and Women's Hospital (US)
- Duke Medical Center (US)
- San Francisco VA Medical Center (US)
- Klinika Kardiologii , Wroclaw ,
- University Medical Center Groningen (NL)
- Corresponding author
- Davison, Beth A.
- ORCID
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-04-25
- Volume
- 18
- Issue
- 8
- Pages
- 1041-1050
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W2342548904
- Cited by
- 67
- References
- 0
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 5 · 2023: 8 · 2022: 5 · 2021: 7 · 2020: 2 · 2019: 7 · 2018: 7 · 2017: 11 · 2016: 6
- FWCI
- 8.53
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- Amgen
- Cytokinetics
- Singulex
- National Institute for Health and Care Research (NF-SI-0611-10227)
- Vifor Pharma
- Servier
- Sphingotec GmbH
- Relypsa
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- acute heart failure, length of hospital stay, 30-day readmission, 90-day mortality, prognostic factors, metabolic dysfunction, renal dysfunction, PROTECT trial, post-discharge outcomes
- MeSH terms
- Acute Disease, Aged, Diabetes Mellitus, Diuretics, Edema, Female, Heart Failure, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Mortality, Patient Readmission, Severity of Illness Index, Xanthines, Comorbidity, Multivariate Analysis, Logistic Models, Proportional Hazards Models, Odds Ratio, Randomized Controlled Trials as Topic, Myocardial Ischemia, Disease Progression, Renal Insufficiency
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