TY - JOUR
T1 - Outcomes of heart failure admissions under observation versus short inpatient stay
AU - Masri, Ahmad
AU - Althouse, Andrew D.
AU - McKibben, Jeffrey
AU - Thoma, Floyd
AU - Mathier, Michael
AU - Ramani, Ravi
AU - Teuteberg, Jeffrey
AU - Marroquin, Oscar
AU - Lee, Joon S.
AU - Mulukutla, Suresh R.
N1 - Publisher Copyright:
© 2018 The Authors.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Background--Patients with heart failure (HF) are admitted either under observation (OBS) or inpatient stays; however, there is little data on whether this designation reflects the clinical status of a patient, with significant logistical and financial implications. We sought to compare the outcomes of patients with HF admitted OBS versus inpatient stay (≤2 days; INPT). Methods and Results--From January 1, 2008 to September 30, 2015, our multisite health system saw 21 339 unique patients totaling 52 493 hospital admissions with a primary diagnosis of HF. Patients were excluded if they underwent cardiac surgery (n=611), heart transplantation (n=187), or left ventricular assist device insertion (n=198), or if they died during hospitalization (n=1839). Of the remaining 50 654 discharges, 2 groups were identified: INPT group and OBS group. Outcomes were HF readmission, all-cause readmission, and all-cause mortality within 1 year of discharge. Hazard ratios were computed using the Andersen-Gill method in the Cox proportional-hazards model. A total of 8709 admissions (17%) occurred in the INPT group and 2648 admissions (5%) occurred in the OBS group. HF readmission rate at 1 year was 55.3% in INPT versus 66.5% in OBS (hazard ratio, 0.75; 95% confidence interval, 0.71-0.80; P < 0.01). All-cause readmission rate at 1 year was 70.7% in INPT versus 82.5% in OBS (hazard ratio, 0.74; 95% confidence interval, 0.70-0.78; P < 0.01). All-cause mortality at 1 year occurred in 25.2% of INPT versus 24.2% of OBS (hazard ratio, 1.03; 95% confidence interval, 0.95-1.12; P=0.46). Conclusions--HF admissions designated INPTs were associated with lower readmission rates and equivalent mortality to those designated OBS.
AB - Background--Patients with heart failure (HF) are admitted either under observation (OBS) or inpatient stays; however, there is little data on whether this designation reflects the clinical status of a patient, with significant logistical and financial implications. We sought to compare the outcomes of patients with HF admitted OBS versus inpatient stay (≤2 days; INPT). Methods and Results--From January 1, 2008 to September 30, 2015, our multisite health system saw 21 339 unique patients totaling 52 493 hospital admissions with a primary diagnosis of HF. Patients were excluded if they underwent cardiac surgery (n=611), heart transplantation (n=187), or left ventricular assist device insertion (n=198), or if they died during hospitalization (n=1839). Of the remaining 50 654 discharges, 2 groups were identified: INPT group and OBS group. Outcomes were HF readmission, all-cause readmission, and all-cause mortality within 1 year of discharge. Hazard ratios were computed using the Andersen-Gill method in the Cox proportional-hazards model. A total of 8709 admissions (17%) occurred in the INPT group and 2648 admissions (5%) occurred in the OBS group. HF readmission rate at 1 year was 55.3% in INPT versus 66.5% in OBS (hazard ratio, 0.75; 95% confidence interval, 0.71-0.80; P < 0.01). All-cause readmission rate at 1 year was 70.7% in INPT versus 82.5% in OBS (hazard ratio, 0.74; 95% confidence interval, 0.70-0.78; P < 0.01). All-cause mortality at 1 year occurred in 25.2% of INPT versus 24.2% of OBS (hazard ratio, 1.03; 95% confidence interval, 0.95-1.12; P=0.46). Conclusions--HF admissions designated INPTs were associated with lower readmission rates and equivalent mortality to those designated OBS.
KW - Admission under observation
KW - Death
KW - Health policy
KW - Heart failure
KW - Outcomes research
KW - Readmission
UR - http://www.scopus.com/inward/record.url?scp=85041696807&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85041696807&partnerID=8YFLogxK
U2 - 10.1161/JAHA.117.007944
DO - 10.1161/JAHA.117.007944
M3 - Article
C2 - 29432132
AN - SCOPUS:85041696807
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 3
M1 - e007944
ER -