Factors associated with unusually long stays in heart failure hospitalizations in Spain

Abstract

Background. Heart failure is a process of high prevalence that causes repeated hospital admissions with increased health care costs. The aim of this article is to describe and characterize the cases with long stays due to this syndrome, identifying associated factors wherever possible. Methods. An historical cohort of all the episodes of people over 45 years with a diagnosis of heart failure admitted in the Spanish Public Health System in the period 1997-2007. Source: 808,229 episodes classified as Diagnosis Related Groups 127 and 544 according to the Minimum Basic Data provided by the Institute for Health Information. We assessed sociodemographic variables (age, gender, region), clinical variables (comorbidities, complications, type of admission and discharge) and management variables (length of stay, type of hospital readmissions). An abnormally prolonged stay (APS) was defined as one exceeding the 90th percentile (14 and 16 days, respectively); we built a logistic regression model to assess their possible associated factors. Results. Eleven point four percent (11.4%) presented abnormally prolonged stays, showing lower mean age and increased number of diagnoses and procedures, readmissions and mortality than the non-abnormally prolonged stay group. Anemia, kidney failure, pulmonary embolism or stroke as well as readmission and scheduled admission were associated with increased likelihood of APS. Conclusion. It is possible to define a comorbidities and sociodemographic profile to assess the likelihood of a prolonged hospital stay, but given the nature of administrative database the model’s discriminative ability is quite discreet.