Factors associated with short stays for patients admitted with acute heart failure
Por:
Carbajosa, V, Javier Martin-Sanchez, F, Llorens, P, Herrero, P, Jacob, J, Alquezar, A, Jose Perez-Dura, M, Alonso, H, Manuel Garrido, J, Torres-Murillo, J, Isabel Lopez-Grima, M, Pinera, P, Fernandez, C, Miro, O and Grp ICA-SEMES
Publicada:
1 dic 2016
Categoría:
Emergency medicine
Resumen:
Objective. To identify factors associated with short hospital stays for
patients admitted with acute heart failure (AHF) admitted to hospitals
with short-stay units (SSU).
Methods. Multicenter nonintervention study in a multipurpose cohort of
patients with AHF to 10 Spanish hospitals with short-stay units;
patients were followed prospectively. We recorded demographic data,
medical histories, baseline cardiorespiratory and function variables on
arrival in the emergency department, on admission, and at 30 days. The
outcome variable was a short hospital stay (<= 4 days). We built
receiver operating characteristic curves of simple and mixed predictive
models for short stays and calculated the area under the curves.
Results. A total of 1359 patients with a mean (SD) age of 78.7 (9.9)
years (53.9% women) were included; 568 (41.8%) had short stays. Five
hundred ninety patients (43.4%) were admitted to SSU and 769 (56.6%)
were admitted to conventional wards. The variables associated with a
short-stay according to the mixed regression model were hypertensive
crisis (odds ratio [OR], 1.79; 95% CI, 1.17-2.73; P=.007) and admission
to a SSU (OR, 16.6; 95% CI, 10.0-33.3; P<.001). Hypotensive AHF (OR,
0.49; 95% CI, 0.26-0.91; P=.025), hypoxemia (OR, 0.68; 95% CI,
0.53-0.88; P=.004); and admission on a Wednesday, Thursday, or Friday
(OR, 0.62; 95% CI, 0.49-0.77; P<.001) were associated with a long stay.
The area under the receiver operating characteristic curve was 0.827
(95% CI, 0.80-0.85; P<.001). Thirty-day mortality and readmission rates
did not differ between patients with short vs long stays (mortality,
0.5% in both cases, P=.959; and readmission, 22.9% vs 27.7%,
respectively; P=.059).
Conclusion. Both clinical and administrative factors are independently
related to whether patients with AHF have short stays in the hospitals
studied, and among therapy, it is remaslcasle the existence of a SSU.
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