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Original Articles

Day of Admission and Clinical Outcomes for Patients Hospitalized for Heart Failure

Findings From the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF)

Gregg C. Fonarow, MD; William T. Abraham, MD; Nancy M. Albert, RN, PhD; Wendy Gattis Stough, PharmD; Mihai Gheorghiade, MD; Barry H. Greenberg, MD; Christopher M. O’Connor, MD; Eduardo Nunez, MD; Clyde W. Yancy, MD and James B. Young, MD

From the Department of Medicine, University of California Los Angeles Medical Center, Los Angeles (G.C.F.); Division of Cardiology, Ohio State University, Columbus (W.T.A.); George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio (N.M.A.); Department of Medicine, Duke University Medical Center, Durham, NC, and Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, NC (W.G.S.); Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill (M.G.); Department of Medicine, University of California San Diego Medical Center, San Diego (B.H.G.); Division of Cardiology, Duke University Medical Center/Duke Clinical Research Institute, Durham, NC (C.M.O.); GlaxoSmithKline, Philadelphia, Penn (E.N.); Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Tex (C.W.Y.); and Department of Cardiovascular Medicine, Heart Failure Section, Cleveland Clinic Foundation, Cleveland, Ohio (J.B.Y.).

Correspondence to Gregg C. Fonarow, MD, Ahmanson–UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Ave, Room 47-123 CHS, Los Angeles, CA 90095-1679. E-mail gfonarow{at}mednet.ucla.edu

Received October 25, 2007; accepted February 1, 2008.

Background— Differences in hospital staffing may influence outcomes for patients with acute conditions, including heart failure (HF), depending on which day of the week the patients are admitted. This study examined the relationship between the day of the week patients are hospitalized for HF and death rate, length of stay (LOS), and rehospitalization rate.

Methods and Results— A total of 259 US hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) submitted data on 48 612 patients with HF. Sixty- to 90-day postdischarge follow-up data were collected prospectively in a prespecified 10% sample. We analyzed day of admission and discharge, demographic, medical history, medication use, laboratory, and in-hospital procedure data for their association with hospital LOS and death rate. Patient characteristics were similar for weekday and weekend presentation. LOS was a median of 4.0 days and a mean of 5.7±5.7 days; in-hospital death rate was 3.8%. In-hospital and postdischarge risk of death were similar for each day of the week in the hospital and follow-up cohorts, respectively. LOS, however, was significantly influenced by day of admission, even after adjustment for other LOS risk factors. The shortest LOS by admission day of the week was Tuesday (5.39 days), and the longest was Friday (5.88 days; P<0.001).

Conclusions— No differences in death rate by day of admission or discharge for HF hospitalizations were evident. Hospitalizations for HF on Thursday and Friday were associated with prolonged LOS. Understanding the factors responsible for the increased LOS and potential adjustments in staffing to facilitate weekend discharges may improve the efficiency of HF hospital care.

Key Words: heart failure • length of stay • registries • mortality • hospitalization

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CLINICAL PERSPECTIVE

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