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Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions.

Publication ,  Journal Article
Fleming, LM; Zhao, X; DeVore, AD; Heidenreich, PA; Yancy, CW; Fonarow, GC; Hernandez, AF; Kociol, RD
Published in: Circ Heart Fail
April 2018

BACKGROUND: Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and stroke patients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality. METHODS AND RESULTS: The study population included 369 hospitals and 285 653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry. We used multivariate logistic regression with generalized estimating equations at the hospital level to identify predictors of EA and determine the association between EA and outcomes. Sixty-five percent of patients ambulated by day 2 of the hospital admission. Patient-level predictors of EA included younger age, male sex, and hospitalization outside of the Northeast (P<0.01 for all). Hospital size and academic status were not predictive. Hospital-level analysis revealed that those hospitals with EA rates in the top 25% were less likely to have a long length of stay (defined as >4 days) compared with those in the bottom 25% (odds ratio, 0.83; confidence interval, 0.73-0.94; P=0.004). Among a subgroup of fee-for-service Medicare beneficiaries, we found that hospitals in the highest quartile of rates of EA demonstrated a statistically significant 24% lower 30-day readmission rates (P<0.0001). Both end points demonstrated a dose-response association and statistically significant P for trend test. CONCLUSIONS: Multivariable-adjusted hospital-level analysis suggests an association between EA and both shorter length of stay and lower 30-day readmissions. Further prospective studies are needed to validate these findings.

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Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

April 2018

Volume

11

Issue

4

Start / End Page

e004634

Location

United States

Related Subject Headings

  • Patient Readmission
  • Patient Discharge
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
  • Fee-for-Service Plans
 

Citation

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Fleming, L. M., Zhao, X., DeVore, A. D., Heidenreich, P. A., Yancy, C. W., Fonarow, G. C., … Kociol, R. D. (2018). Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions. Circ Heart Fail, 11(4), e004634. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004634
Fleming, Lisa M., Xin Zhao, Adam D. DeVore, Paul A. Heidenreich, Clyde W. Yancy, Gregg C. Fonarow, Adrian F. Hernandez, and Robb D. Kociol. “Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions.Circ Heart Fail 11, no. 4 (April 2018): e004634. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004634.
Fleming LM, Zhao X, DeVore AD, Heidenreich PA, Yancy CW, Fonarow GC, et al. Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions. Circ Heart Fail. 2018 Apr;11(4):e004634.
Fleming, Lisa M., et al. “Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions.Circ Heart Fail, vol. 11, no. 4, Apr. 2018, p. e004634. Pubmed, doi:10.1161/CIRCHEARTFAILURE.117.004634.
Fleming LM, Zhao X, DeVore AD, Heidenreich PA, Yancy CW, Fonarow GC, Hernandez AF, Kociol RD. Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions. Circ Heart Fail. 2018 Apr;11(4):e004634.

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

April 2018

Volume

11

Issue

4

Start / End Page

e004634

Location

United States

Related Subject Headings

  • Patient Readmission
  • Patient Discharge
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
  • Fee-for-Service Plans