Background:
Heart failure (HF) admissions are frequent and result in significant expenditures. Identifying predictors of increased length of stay (LOS), particularly above the median LOS, may help providers set expectations for patients and target resources effectively.
Methods:
We analyzed HF admissions (n= 70,094) from January 2005 through April 2007 from 246 hospitals in the AHA's Get With The Guidelines-HF program. In a subset with BNP (n=44,535), baseline characteristics, admission vital signs and selected labs (BNP, creatinine, BUN, hemoglobin, and sodium) were included in a multivariable regression analysis to determine factors associated with LOS ≥4 days.
Results:
Patients were median age of 72, 45% female, 53% had ischemic etiology, and median LVEF was 35%. Median LOS was 4 days (25
th
,75
th
2,6). The most significant predictors of LOS ≥ 4 days were a higher admission BUN, higher heart rate, and lower SBP (Table 1). Age, insurance, race, creatinine, and LVEF were not.
Conclusion:
Upon admission for HF, certain vital signs, comorbidites, and laboratory values are associated with an increased likelihood of a LOS ≥ 4 days. These observations may be of value in the implementation of interventions aimed at reducing LOS and improving quality of care in HF.
Variables Associated With Hospital LOS >/= 4 Days
Variable
Chi-Square
OR
Lower (95% CI)
Upper (95% CI)
P-value
Admissioun BUN (/1 unit increase)
221.8
1.01
1.01
1.01
<.001
Admission SBP (/ 10-unit increase)
129.6
0.96
0.95
0.96
<.001
Heart Rate (/ 10-unit increase)
122.4
1.07
1.06
1.09
<.001
History of COPD/Asthma
45.8
1.19
1.13
1.25
<.001
Admission BNP (per 100-unit increase)
37.6
1.01
1.00
1.01
<.001
Female vs. Male
29.7
1.12
1.08
1.17
<.001
History of renal insufficiency
27.4
1.17
1.10
1.24
<.001
History of heart failure
18.0
0.89
0.85
0.94
<.001
Region: (MW vs. NE)
(S vs NE)
(W vs. NE)
17.3
0.71
0.91
0.71
0.60
.077
0.56
0.85
1.08
0.88
<.001
Anticipating pediatric patient transfers from intermediate to intensive care