Lisa M Fleming1, Xin Zhao1, Adam D DeVore1, Paul A Heidenreich1, Clyde W Yancy1, Gregg C Fonarow1, Adrian F Hernandez1, Robb D Kociol2. 1. Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.). 2. Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.). robb.kociol@umassmemorial.org.
Abstract
BACKGROUND: Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and stroke patients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality. METHODS AND RESULTS: The study population included 369 hospitals and 285 653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry. We used multivariate logistic regression with generalized estimating equations at the hospital level to identify predictors of EA and determine the association between EA and outcomes. Sixty-five percent of patients ambulated by day 2 of the hospital admission. Patient-level predictors of EA included younger age, male sex, and hospitalization outside of the Northeast (P<0.01 for all). Hospital size and academic status were not predictive. Hospital-level analysis revealed that those hospitals with EA rates in the top 25% were less likely to have a long length of stay (defined as >4 days) compared with those in the bottom 25% (odds ratio, 0.83; confidence interval, 0.73-0.94; P=0.004). Among a subgroup of fee-for-service Medicare beneficiaries, we found that hospitals in the highest quartile of rates of EA demonstrated a statistically significant 24% lower 30-day readmission rates (P<0.0001). Both end points demonstrated a dose-response association and statistically significant P for trend test. CONCLUSIONS: Multivariable-adjusted hospital-level analysis suggests an association between EA and both shorter length of stay and lower 30-day readmissions. Further prospective studies are needed to validate these findings.
BACKGROUND: Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and strokepatients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality. METHODS AND RESULTS: The study population included 369 hospitals and 285 653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry. We used multivariate logistic regression with generalized estimating equations at the hospital level to identify predictors of EA and determine the association between EA and outcomes. Sixty-five percent of patients ambulated by day 2 of the hospital admission. Patient-level predictors of EA included younger age, male sex, and hospitalization outside of the Northeast (P<0.01 for all). Hospital size and academic status were not predictive. Hospital-level analysis revealed that those hospitals with EA rates in the top 25% were less likely to have a long length of stay (defined as >4 days) compared with those in the bottom 25% (odds ratio, 0.83; confidence interval, 0.73-0.94; P=0.004). Among a subgroup of fee-for-service Medicare beneficiaries, we found that hospitals in the highest quartile of rates of EA demonstrated a statistically significant 24% lower 30-day readmission rates (P<0.0001). Both end points demonstrated a dose-response association and statistically significant P for trend test. CONCLUSIONS: Multivariable-adjusted hospital-level analysis suggests an association between EA and both shorter length of stay and lower 30-day readmissions. Further prospective studies are needed to validate these findings.
Authors: K Lambe; S Guerra; G Salazar de Pablo; S Ayis; I D Cameron; N E Foster; E Godfrey; C L Gregson; F C Martin; C Sackley; N Walsh; K J Sheehan Journal: BMC Geriatr Date: 2022-06-11 Impact factor: 4.070