Risk Factors and Clinical Outcomes of Nonhome Discharge in Patients With Acute Decompensated Heart Failure: An Observational Study

Koichi Washida, Takao Kato, Neiko Ozasa, Takeshi Morimoto, Hidenori Yaku, Yasutaka Inuzuka, Yodo Tamaki, Yuta Seko, Erika Yamamoto, Yusuke Yoshikawa, Takeshi Kitai, Yugo Yamashita, Moritake Iguchi, Kazuya Nagao, Yuichi Kawase, Takashi Morinaga, Mamoru Toyofuku, Yutaka Furukawa, Kenji Ando, Kazushige Kadota, Yukihito Sato, Koichiro Kuwahara, Takeshi Kimura, Koichi Washida, Takao Kato, Neiko Ozasa, Takeshi Morimoto, Hidenori Yaku, Yasutaka Inuzuka, Yodo Tamaki, Yuta Seko, Erika Yamamoto, Yusuke Yoshikawa, Takeshi Kitai, Yugo Yamashita, Moritake Iguchi, Kazuya Nagao, Yuichi Kawase, Takashi Morinaga, Mamoru Toyofuku, Yutaka Furukawa, Kenji Ando, Kazushige Kadota, Yukihito Sato, Koichiro Kuwahara, Takeshi Kimura

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/m2 (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.

Keywords: clinical outcome; heart failure; home discharge; prospective.

Conflict of interest statement

None.

Figures

Figure 1. Study flowchart.
Figure 1. Study flowchart.
ADHF indicates acute decompensated heart failure; and KCHF, Kyoto Congestive Heart Failure.
Figure 2. Kaplan–Meier curves for the mortality…
Figure 2. Kaplan–Meier curves for the mortality outcomes: home discharge versus non‐home discharge groups
(A) All‐cause death, (B) cardiovascular death, and (C) noncardiovascular death.

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Source: PubMed

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