Author + information
- Received January 4, 2017
- Revision received March 20, 2017
- Accepted March 27, 2017
- Published online May 10, 2017.
- Maneesh Sud, MDa,
- Bing Yu, PhDa,
- Harindra C. Wijeysundera, MD, PhDa,b,c,d,e,
- Peter C. Austin, PhDa,b,d,e,
- Dennis T. Ko, MD, MSca,b,c,d,e,
- Juarez Braga, MDe,
- Peter Cram, MD, MBAa,b,e,f,
- John A. Spertus, MD, MPHg,
- Michael Domanski, MDe,h and
- Douglas S. Lee, MD, PhDa,b,e,h,i,∗ ()
- aInstitute for Clinical Evaluative Sciences University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
- bInstitute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- cSunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- dSchulich Heart Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- eDivision of Cardiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- fDivision of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- gUniversity of Missouri, Kansas City, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
- hPeter Munk Cardiac Centre of the University Health Network, Toronto, Ontario, Canada
- iJoint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
- ↵∗Address for correspondence:
Dr. Douglas S. Lee, Institute for Clinical Evaluative Sciences, Division of Cardiology, University Health Network–Toronto General Hospital, NU 4-482, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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.
Primary funding for this study was provided by the Canadian Institutes of Health Research. The Institute for Clinical Evaluative Sciences is supported in part by a grant from the Ontario Ministry of Health and Long Term Care. The opinions, results, and conclusions are those of the authors, and no endorsement by the Ministry of Health and Long-Term Care or by the Institute for Clinical Evaluative Sciences is intended or should be inferred. Parts of this material are founded on data and information compiled and provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions, and statements expressed herein are those of the author and not necessarily those of Canadian Institute for Health Information. This research was supported by a foundation grant from the Canadian Institutes of Health Research (CIHR FDN 148446). Dr. Lee is supported by a midcareer investigator award from the Heart and Stroke Foundation; and is the Ted Rogers Chair in Heart Function Outcomes, a joint Hospital-University Chair of the University Health Network and the University of Toronto. Dr. Austin is a career investigator of the Heart and Stroke Foundation of Ontario. Dr. Wijeysundera is supported by a Distinguished Clinician Scientist Award from the Heart and Stroke Foundation of Canada. Dr. Ko is supported by a midcareer investigator award from the Heart and Stroke Foundation. Dr. Spertus is the Daniel Lauer/Missouri Endowed Chair and Professor. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 4, 2017.
- Revision received March 20, 2017.
- Accepted March 27, 2017.
- 2017 The Authors