Influence of hospital length of stay for heart failure on quality of care.

Adherence to treatment guidelines during hospital admissions for heart failure impacts readmissions and mortality. However, the relation between guideline adherence and heart failure hospital length of stay (LOS) has not been well studied. Whether quality of care delivered to patients with heart failure is impacted on by hospital LOS was assessed. Data were analyzed from 209 hospitals participating in the Get With the Guidelines heart failure program. From January 2005 to September 2006, a total of 36,078 admissions were recorded and stratified by a median heart failure hospitalization LOS of <5 or >or=5 days. Comparisons of baseline patient characteristics and quality measures were analyzed using generalized estimating equations. Patients with LOS >or=5 days were slightly older, more likely to be seen at a larger hospital, and had higher ejection fractions and increased rates of such co-morbidities as diabetes, anemia, renal insufficiency, and pulmonary disease. After adjustment, longer LOS was associated with an increased odds ratio (OR) per each additional day for providing discharge instructions (OR 1.027, 95% confidence interval [CI] 1.017 to 1.038) and left ventricular ejection fraction documentation (OR 1.049, 95% CI 1.031 to 1.067). However, LOS >or=5 days was independently associated with modestly decreased use of life-prolonging medications at hospital discharge for patients with left ventricular systolic dysfunction: angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR 0.977, 95% CI 0.967 to 0.987) and beta blockers (OR 0.990, 95% CI 0.982 to 0.997). In conclusion, in Get With the Guidelines participating institutions, hospital LOS had only a modest influence on quality-of-care measures. Overall, excellent adherence to guideline-based medical therapy was observed, even in patients with a shorter hospital LOS.

Duke Scholars

Author Adrian Felipe Hernandez Medicine, Cardiology