Affiliation:
1. Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
2. Clinical Epidemiology Hyogo College of Medicine Nishinomiya Japan
3. Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan
4. Cardiovascular Medicine Shiga General Hospital Moriyama Japan
5. Division of Cardiology Tenri Hospital Nara Japan
6. Department of Cardiovascular Medicine Kobe City Medical Center General Hospital Hyogo Japan
7. Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
8. Department of Cardiology Osaka Red Cross Hospital Osaka Japan
9. Department of Cardiology Kurashiki Central Hospital Okayama Japan
10. Department of Cardiology Kokura Memorial Hospital Fukuoka Japan
11. Department of Cardiology Japanese Red Cross Wakayama Medical Center Wakayama Japan
12. Department of Cardiology Hyogo Prefectural Amagasaki General Medical Center Hyogo Japan
13. Department of Cardiovascular Medicine Shinshu University Graduate School of Medicine Nagano Japan
Abstract
Background
No clinical studies have focused on the factors associated with discharge destination in patients with acute decompensated heart failure.
Methods and Results
Of 4056 consecutive patients hospitalized for acute decompensated heart failure in the KCHF (Kyoto Congestive Heart Failure) registry, we analyzed 3460 patients hospitalized from their homes and discharged alive. There were 3009 and 451 patients who were discharged to home and nonhome, respectively. We investigated the factors associated with nonhome discharge and compared the outcomes between home discharge and nonhome discharge. Factors independently and positively associated with nonhome discharge were age ≥80 years (odds ratio [OR],1.76; 95% CI,1.28–2.42), body mass index ≤22 kg/m
2
(OR,1.49; 95% CI,1.12–1.97), poor medication adherence (OR, 2.08; 95% CI,1.49–2.88), worsening heart failure (OR, 2.02; 95% CI, 1.46–2.82), stroke during hospitalization (OR, 3.74; 95% CI, 1.75–8.00), functional decline (OR, 12.24; 95% CI, 8.74–17.14), and length of hospital stay >16 days (OR, 4.14; 95% CI, 3.01–5.69), while those negatively associated were diabetes mellitus (OR, 0.69; 95% CI, 0.51–0.94), cohabitants (OR, 0.62; 95% CI, 0.46–0.85), and ambulatory state before admission (OR, 0.25; 95% CI, 0.18–0.36). The cumulative 1‐year incidence of all‐cause death was significantly higher in the nonhome discharge group than in the home discharge group. The nonhome discharge group compared with the nonhome discharge group was associated with a higher adjusted risk for all‐cause death (hazard ratio, 1.66;
P
<0.001).
Conclusions
The discharge destination of patients with acute decompensated heart failure is influenced by factors such as prehospital social background, age, body mass index, low self‐care ability, events during hospitalization (worsening heart failure, stroke, etc), functional decline, and length of hospital stay; moreover, the prognosis of nonhome discharge patients is worse than that of home discharge patients.
Registration Information
clinicaltrials.gov. Identifier: NCT02334891.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine