2nd Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
Kardiol Pol. 2017;75(4):323-331. doi: 10.5603/KP.a2016.0183. Epub 2016 Dec 20.
Heart failure (HF) is a chronic disease with poor prognosis, being the final stage of many cardiovascular conditions and often requiring hospitalisation.
The aim of the study was to evaluate the effect of hospitalisation length on prognosis in patients with HF.
Between February 2012 and January 2013, in 32 cardiology centres in Poland, 1126 HF patients were included in the EURObservational Research Programme on Heart Failure Registry. A total of 765 persons were hospitalised. A follow-up (FU) of 414 ± 121 days was conducted.
The median length of hospitalisation was seven days (interquartiles 25th-75th; 4-11), also for new onset (14.5% of patients) and chronic HF (seven days, 5-11 and 4-11, respectively). Patients who died during FU (16.5%) and those who survived were hospitalised for a median of eight days (6-12) and seven days (4-10), respectively (p < 0.001). Patients hospitalised for 8-21 and 22 or more days had an increased risk of death after discharge (hazard ratio [HR] 1.70; 95% confidence interval [CI] 1.16-2.49 and HR 2.20; 95% CI 1.04-4.67, respectively) than those hospitalised for up to seven days. Predictors of death in the FU period in multivariate analysis included age (1.02; 95% CI 1.01-1.04), history of chronic kidney disease (CKD) (HR 1.55; 95% CI 1.05-2.30), and New York Heart Association (NYHA) class III (HR 2.52; 95% CI 1.22-5.18) and IV (HR 4.77; 95% CI 2.32-9.82) at admission. Patients hospitalised for 22 or more days were more often male (77%), and with a history of CKD (34%). At admission they had lower systolic (118 ± 25 mm Hg) and diastolic (72 ± 12 mm Hg) blood pressure, higher NT-proBNP (9191 ± 8776 pg/mL), lower serum sodium level (137 ± 5 mmol/l), as well as lower ejection fraction before and during hospital stay (30 ± 12% and 34 ± 14%, respectively; p < 0.05 for all factors). Factors that influenced the length of hospital stay included history of CKD (p < 0.001), current malignancy (p = 0.026), and infection at admission (p < 0.001). Most of the admitted patients presented NYHA class III (45%). The poorer the NYHA class at admission, the longer the patient's hospital stay (p < 0.001). 54% patients were re-admitted to the hospital during FU. Patients re-admitted and not re-admitted during the one-year FU had the same median duration of the index hospitalisation (seven days; 4-10 and 4-11, respectively; p = 0.957).
Patients with HF hospitalised for 22 or more days, in comparison to patients hospitalised for less than eight days, had double the risk of death during FU. We believe that prolonged hospitalisation might be regarded as a marker of poor prognosis in patients with acute HF.
心力衰竭（HF）是一种预后不良的慢性疾病，是许多心血管疾病的终末阶段，通常需要住院治疗。
本研究旨在评估住院时间长短对心力衰竭患者预后的影响。
2012 年 2 月至 2013 年 1 月期间，在波兰的 32 个心脏病学中心，1126 名 HF 患者被纳入 EURObservational Research Programme on Heart Failure 登记处。共有 765 人住院。进行了 414±121 天的随访（FU）。
中位住院时间为 7 天（四分位间距 25%-75%：4-11），新发（14.5%的患者）和慢性 HF（7 天，5-11 和 4-11）的住院时间也分别为 7 天。在 FU 期间死亡的患者（16.5%）和存活的患者住院中位数分别为 8 天（6-12）和 7 天（4-10）（p<0.001）。住院 8-21 天和 22 天及以上的患者出院后死亡风险增加（风险比[HR] 1.70；95%置信区间[CI] 1.16-2.49 和 HR 2.20；95%CI 1.04-4.67）比住院 7 天以下的患者。多变量分析中 FU 期间死亡的预测因素包括年龄（1.02；95%CI 1.01-1.04）、慢性肾脏病（CKD）病史（HR 1.55；95%CI 1.05-2.30）和纽约心脏协会（NYHA）III 级（HR 2.52；95%CI 1.22-5.18）和 IV 级（HR 4.77；95%CI 2.32-9.82）入院时。住院 22 天以上的患者多为男性（77%），且有 CKD 病史（34%）。入院时，他们的收缩压（118±25mmHg）和舒张压（72±12mmHg）较低，NT-proBNP 水平较高（9191±8776pg/mL），血清钠水平较低（137±5mmol/L），以及住院期间射血分数较低（30±12%和 34±14%；所有因素的 p 值均<0.05）。影响住院时间的因素包括 CKD 病史（p<0.001）、当前恶性肿瘤（p=0.026）和入院时感染（p<0.001）。大多数入院患者的 NYHA 分级为 III 级（45%）。入院时 NYHA 分级越差，患者住院时间越长（p<0.001）。54%的患者在 FU 期间再次住院。在 1 年 FU 期间再次和未再次住院的患者，其指数住院时间中位数相同（7 天；4-10 和 4-11，分别；p=0.957）。
与住院时间少于 8 天的患者相比，住院时间超过 22 天的 HF 患者在 FU 期间死亡的风险增加一倍。我们认为，延长住院时间可能被视为急性 HF 患者预后不良的标志。
