The effect of the day of the week of discharge on mortality and readmissions in patients hospitalized due to heart failure.
, 1, 2
Abstract
Background The effect of the day of the week of discharge on mortality and readmissions in patients hospitalized due to heart failure (HF) remains unclear. The aim was to determine the effect of the day of the week of discharge of HF patients on 30-day and one-year mortality and rehospitalizations. Methods Inclusion criteria were hospitalization due to HF exacerbation in the 2013 year according to the National Health Fund data. The primary outcome variable was all-cause mortality and the secondary the first readmission due to HF exacerbation. Survival analysis was performed for outcomes according to the day of the week of discharge adjusting for age, sex, duration of the hospitalization, HF severity, type of ward, and fulfilling prescription for selected medications within the 30-day post-hospitalization period. Results The analysis included 96219 patients (median age 77.0 yrs., 46.3% males). The mean all-cause one-year mortality was the highest on Sundays then compared with other days separately in the Cox analysis (HR 1.40; 95 CI 1.23-1.59; p<0.001) and also then compared to the other weekdays pulled (27.8% vs. 21.8%, p<0.001). The 30-day mortality was the highest for Sunday discharges in the Cox analysis (HR 2.14; 95 CI 1.78-2.57; p<0.001). The day of the week of discharge did not affect rehospitalization rates. Conclusions The day of the week of discharge of HF patients matters as it may be related to the prognosis.
Keywords: day of the weekheart failuremortalityreadmission
References
- Ponikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016; 37(27): 2129–2200.
- Fonarow G, Abraham W, Albert N, et al. OPTIMIZE-HF Investigators and Coordinators. Carvedilol use at discharge in patients hospitalized for heart failure is associated with improved survival: an analysis from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J. 200; 153(1): e1–e11.
- Horwich TB, Hernandez AF, Liang Li, et al. Get With Guidelines Steering Committee and Hospitals. Weekend hospital admission and discharge for heart failure: association with quality of care and clinical outcomes. Am Heart J. 2009; 158(3): 451–458.
- Gallerani M, Boari B, Manfredini F, et al. Weekend versus weekday hospital admissions for acute heart failure. Int J Cardiol. 2011; 146(3): 444–447.
- Hamaguchi S, Kinugawa S, Tsuchihashi-Makaya M, et al. Weekend versus weekday hospital admission and outcomes during hospitalization for patients due to worsening heart failure: a report from Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Heart Vessels. 2014; 29(3): 328–335.
- McAlister FA, Au AG, Majumdar SR, et al. Postdischarge outcomes in heart failure are better for teaching hospitals and weekday discharges. Circ Heart Fail. 2013; 6(5): 922–929.
- Balsam P, Ozierański K, Kapłon-Cieślicka A, et al. Differences in clinical characteristics and 1-year outcomes of hospitalized patients with heart failure in ESC-HF Pilot and ESC-HF-LT registries. Pol Arch Intern Med. 2019; 129(2): 106–116.
- Dharmarajan K, Krumholz HM. Risk after hospitalization: we have a lot to learn. J Hosp Med. 2015; 10(2): 135–136.
- van Walraven C, Taljaard M, Etchells E, et al. Risk of death or readmission among people discharged from hospital on Fridays. CMAJ. 2002; 166(13): 1672–1673.
- McAlister FA, Youngson E, Padwal RS, et al. Similar outcomes among general medicine patients discharged on weekends. J Hosp Med. 2015; 10(2): 69–74.
- Dharmarajan K, Krumholz HM. Strategies to Reduce 30-Day Readmissions in Older Patients Hospitalized with Heart Failure and Acute Myocardial Infarction. Curr Geriatr Rep. 2014; 3(4): 306–315.