Division of Cardiology, Emory University, Atlanta, GA, USA.
Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Eur J Heart Fail. 2015 Oct;17(10):1022-31. doi: 10.1002/ejhf.282. Epub 2015 May 9.
Previous reports have provided conflicting data regarding the relationship between length of stay (LOS) and subsequent readmission risk among patients hospitalized for heart failure (HF).
We performed a post-hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial to evaluate the differences in LOS overall and between geographic regions (North America, South America, Western Europe, and Eastern Europe) in association with all-cause and cause-specific [HF, cardiovascular (CV) non-HF, and non-CV] readmissions within 30 days of discharge after HF hospitalization. The present analysis included 4020 patients enrolled from 20 countries who were alive at discharge. Median [interquartile range (IQR)] LOS was 8 (4-11) days. The 30-day readmission rates were 15.7% [95% confidence interval (CI) 14.6-16.8] for all-cause; 5.6% (95% CI 4.9-6.3) for HF; 4.4% (95% CI 3.8-5.1) for CV non-HF; and 5.8% (95% CI 5.1-6.6) for non-CV readmissions. There was a positive correlation between LOS and all-cause readmissions (r = 0.09, 95% CI 0.06-0.12). The adjusted odds ratio for the top (≥14 days) vs. the bottom (≤3 days) quintile for LOS was 1.39 (95% CI 0. 92-2.11) for all-cause readmissions, 0.43 (95% CI 0.24-0.79) for HF, 2.99 (95% CI 1.49-6.02) for CV non-HF, and 1.72 (95% CI 1.05-2.81) for non-CV readmissions. With the exception of Western Europe, these findings remained largely consistent across geographic regions.
In this large multinational cohort of hospitalized HF patients, longer LOS was associated with a higher risk for all-cause, CV non-HF, and non-CV readmissions, but a lower risk of HF readmissions within 30 days of discharge. These results may inform strategies to reduce readmissions.
先前的报告提供了相互矛盾的数据，表明心力衰竭（HF）住院患者的住院时间（LOS）与随后的再入院风险之间存在关系。
我们对 Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan（EVEREST）试验进行了事后分析，以评估 LOS 总体差异以及在 HF 住院后 30 天内与全因和病因特异性[HF、心血管（CV）非 HF 和非 CV]再入院相关的 LOS 差异。本分析包括来自 20 个国家的 4020 名存活出院患者。中位（四分位距（IQR））LOS 为 8（4-11）天。全因再入院率为 15.7%（95%置信区间（CI）14.6-16.8）；HF 为 5.6%（95%CI 4.9-6.3）；CV 非 HF 为 4.4%（95%CI 3.8-5.1）；非 CV 再入院率为 5.8%（95%CI 5.1-6.6）。LOS 与全因再入院之间呈正相关（r=0.09，95%CI 0.06-0.12）。LOS 最高（≥14 天）与最低（≤3 天）五分位组的调整比值比为全因再入院 1.39（95%CI 0.92-2.11），HF 为 0.43（95%CI 0.24-0.79），CV 非 HF 为 2.99（95%CI 1.49-6.02），非 CV 再入院为 1.72（95%CI 1.05-2.81）。除了西欧，这些发现基本在各地区保持一致。
在这项针对 HF 住院患者的大型跨国队列研究中，较长的 LOS 与全因、CV 非 HF 和非 CV 再入院的风险增加相关，但 HF 再入院的风险降低出院后 30 天内。这些结果可能为减少再入院的策略提供信息。
