Omar H R, Guglin M
Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA.
Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
Herz. 2018 Mar;43(2):131-139. doi: 10.1007/s00059-016-4532-3. Epub 2017 Feb 6.
Increased length of stay (LOS) during acute heart failure (HF) hospitalization is associated with readmission and mortality.
The ESCAPE trial data were utilized to identify determinants and post-discharge outcomes of patients with acute systolic HF requiring longer-than-average LOS (≥7 days). The study endpoints were 6‑month all-cause mortality, all-cause rehospitalization, and the composite endpoint of death, cardiac rehospitalization, and cardiac transplant.
Among the 424 patients with recorded LOS, 216 (50.9%) and 208 (49.1%) had LOS ≥ or <7 days, respectively. Independent determinants of longer-than-average LOS included older age (OR per 10-year increase: 1.759, 95% CI: 1.120-2.763, p = 0.014), higher blood urea nitrogen (OR per 5 mg/dl increase: 1.202, 95% CI: 1.024-1.410, p = 0.024), greater inferior vena cava diameter (OR per 1 cm increase: 2.453, 95% CI: 1.175-5.121, p = 0.017), and lower sodium (OR per 4 mmol/l increase: 0.494, 95% CI: 0.268-0.911, p = 0.024). We found a significant correlation between right-sided failure (right atrial pressure) and LOS (r = 0.229, p = 0.001) but not left-sided failure (pulmonary capillary wedge pressure, r = 0.099, p = 0.177). Patients with longer-than-average LOS had a significantly higher mortality (25.9% vs. 12%, univariate OR: 2.562, 95% CI: 1.528-4.296, p < 0.001), higher all-cause rehospitalization (63% vs. 53.4%, univariate OR: 1.486, 95% CI: 1.008-2.190, p = 0.046) and higher frequency of the composite endpoint of death, cardiac rehospitalization, and cardiac transplant (61.6% vs. 45.2%, univariate OR: 1.943, 95% CI: 1.320-2.862, p = 0.001) compared with an LOS of <7 days. Cox proportional hazard analysis showed that a longer-than-average LOS was an independent predictor of 6‑month all-cause mortality (HR: 1.930, 95% CI: 1.112-3.350, p = 0.019).
In acute HF, right ventricular failure and renal dysfunction predict longer-than-average LOS, which is a proxy for more severe HF and is associated with worse postdischarge outcomes.
急性心力衰竭（HF）住院期间住院时间（LOS）延长与再入院和死亡率相关。
利用ESCAPE试验数据确定急性收缩性HF患者LOS长于平均水平（≥7天）的决定因素和出院后结局。研究终点为6个月全因死亡率、全因再住院率以及死亡、心脏再住院和心脏移植的复合终点。
在记录了LOS的424例患者中，分别有216例（50.9%）和208例（49.1%）的LOS≥或<7天。LOS长于平均水平的独立决定因素包括年龄较大（每增加10岁的OR：1.759，95%CI：1.120 - 2.763，p = 0.014）、血尿素氮较高（每增加5mg/dl的OR：1.202，95%CI：1.024 - 1.410，p = 0.024）、下腔静脉直径较大（每增加1cm的OR：2.453，95%CI：1.175 - 5.121，p = 0.017）以及血钠较低（每增加4mmol/l的OR：0.494，95%CI：0.268 - 0.911，p = 0.024）。我们发现右侧心力衰竭（右心房压力）与LOS之间存在显著相关性（r = 0.229，p = 0.001），但左侧心力衰竭（肺毛细血管楔压）与LOS之间无显著相关性（r = 0.099，p = 0.177）。与LOS<7天的患者相比，LOS长于平均水平的患者死亡率显著更高（25.9%对12%，单因素OR：2.562，95%CI：1.528 - 4.296，p<0.001）、全因再住院率更高（63%对53.4%，单因素OR：1.486，95%CI：1.008 - 2.190，p = 0.046）以及死亡、心脏再住院和心脏移植复合终点的发生率更高（61.6%对45.2%，单因素OR：1.943，95%CI：1.320 - 2.862，p = 0.001）。Cox比例风险分析显示，LOS长于平均水平是6个月全因死亡率的独立预测因素（HR：1.930，95%CI：1.112 - 3.350，p = 0.019）。
在急性HF中，右心室衰竭和肾功能不全预示LOS长于平均水平，这是更严重HF的一个指标，且与更差的出院后结局相关。
