Associations between short or long length of stay and 30-day readmission and mortality in hospitalized patients with heart failure
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OBJECTIVES: This study sought to examine the associations between heart failure (HF)-related hospital length of stay and 30-day readmissions and HF hospital length of stay and mortality rates. BACKGROUND: Although reducing HF readmission and mortality rates are health care priorities, how HF-related hospital length of stay affects these outcomes is not fully known. METHODS: A population-level, multicenter cohort study of 58,230 patients with HF (age >65 years) was conducted in Ontario, Canada between April 1, 2003 and March 31, 2012. RESULTS: When length of stay was modeled as continuous variable, its association with the rate of cardiovascular readmission was nonlinear (p < 0.001 for nonlinearity) and U-shaped. When analyzed as a categorical variable, there was a higher rate of cardiovascular readmission for short (1 to 2 days; adjusted hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 1.04 to 1.21; p = 0.003) and long (9 to 14 days; HR: 1.11; 95% CI: 1.04 to 1.19; p = 0.002) lengths of stay as compared with 5 to 6 days (reference). Hospital readmissions for HF demonstrated a similar nonlinear (p = 0.005 for nonlinearity) U-shaped relationship with increased rates for short (HR: 1.15; 95% CI: 1.04 to 1.27; p = 0.006) and long (HR: 1.14; 95% CI: 1.04 to 1.25; p = 0.004) lengths of stay. Noncardiovascular readmissions demonstrated increased rates with long (HR: 1.17; 95% CI: 1.07 to 1.29; p < 0.001) and decreased rates with short (HR: 0.87; 95% CI: 0.79 to 0.96; p = 0.006) lengths of stay (p = 0.53 for nonlinearity). The 30-day mortality risk was highest after a long length of stay (HR: 1.28; 95% CI: 1.14 to 1.43; p < 0.001). CONCLUSIONS: A short length of stay after hospitalization for HF is associated with increased rates of cardiovascular and HF readmissions but lower rates of noncardiovascular readmissions. A long length of stay is associated with increased rates of all types of readmission and mortality.
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In registries of hospitalized HF patients in North America and Europe, the prevalence of T2DM is around 40-45%.
“In registries of hospitalized HF patients in North America and Europe, the prevalence of T2DM is around 40-45%, 49 -52”
From Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology (2018) · cites this paper as [50]
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Self-citation
- Authors
- Sud, M., Yu, B., Wijeysundera, H. C., Austin, P. C., Ko, D. T., Braga, J., Cram, P., Spertus, J. A., Domanski, M., & Lee, D. S.
- Affiliations
- University Health Network (CA)
- Sunnybrook Health Science Centre (CA)
- University of Toronto (CA)
- University of Missouri–Kansas City (US)
- Corresponding author
- Lee, Douglas S.
- ORCID
- Venue
- JACC Heart Failure
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 5
- Issue
- 8
- Pages
- 578-588
- ISSN
- 2213-1779 (ISSN-L)
- OpenAlex
- W2612176626
- Cited by
- 135
- References
- 37
- Citations by year
- 2026: 13 · 2025: 14 · 2024: 9 · 2023: 10 · 2022: 13 · 2021: 19 · 2020: 25 · 2019: 18 · 2018: 8 · 2017: 6
- FWCI
- 12.07
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- JACC Heart Failure (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- heart failure, length of hospital stay, 30-day readmission, 30-day mortality, U-shaped relationship, cardiovascular readmission, older adults, hospitalized patients, hospital discharge timing, quality of care, health care costs, Ontario health system, mortality risk
- MeSH terms
- Multiple Chronic Conditions, Aged, Aged, 80 and over, Coronary Care Units, Female, Heart Failure, Humans, Length of Stay, Male, Ontario, Patient Readmission, Retrospective Studies, Hospital Mortality
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