RESUMO
OBJECTIVE: To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. METHODS: Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (<6/6-10/11-15/>15â¯days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6â¯days vs. LOH <6â¯days (reference), and stratified by hospitalisation in cardiology, internal medicine, geriatrics, or short-stay units. RESULTS: We included 8563 patients (mean age: 80 (SDâ¯=â¯10) years, 55.5% women), with a median LOH of 7â¯days (IQR 4-11): 2934 (34.3%) had a LOH <6â¯days, 3184 (37.2%) 6-10â¯days, 1287 (15.0%) 11-15â¯days, and 1158 (13.5%) >15â¯days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CIâ¯=â¯13.0-64.9) when LOH was 11-15â¯days, and by 72.0% (95%CIâ¯=â¯42.6-107.5) when >15â¯days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CIâ¯=â¯8.4-36.4) for LOH >15â¯days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15â¯days and no significant increments in readmission risk. CONCLUSIONS: Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments.
Assuntos
Insuficiência Cardíaca/mortalidade , Unidades Hospitalares/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar/tendências , Humanos , Masculino , Modelos de Riscos Proporcionais , Fatores de Risco , Espanha/epidemiologia , Volume Sistólico , Taxa de Sobrevida/tendências , Fatores de TempoRESUMO
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