Outcomes of heart failure admissions under observation versus short inpatient stay

Ahmad Masri, Andrew D. Althouse, Jeffrey McKibben, Floyd Thoma, Michael Mathier, Ravi Ramani, Jeffrey Teuteberg, Oscar Marroquin, Joon S. Lee, Suresh R. Mulukutla

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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.

Original languageEnglish (US)
Article numbere007944
JournalJournal of the American Heart Association
Issue number3
StatePublished - Feb 1 2018
Externally publishedYes


  • Admission under observation
  • Death
  • Health policy
  • Heart failure
  • Outcomes research
  • Readmission

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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