Shorter Stays are Good News

Heart failure hospital stay may be shorter with ongoing medical care

(RxWiki News) Heart failure is the leading cause of hospital stays. It racks up 6.5 million hospital days a year. This creates a huge financial burden for everyone. Helping patients get ongoing medical care can shorten hospital stays.

Overall, most patients are spending fewer days in the hospital. This is not the case with heart failure patients. A recent study found that heart failure patients on Medicaid and with additional diseases have up to three days longer hospital stays.

These patients may have trouble getting good health care out-of-hospital. They are not able to manage their symptoms. This can lead to more hospitalizations. 

"Talk to your cardiologist about at home care."

Randi E. Forak, of National Association of Healthcare Quality, and colleagues led the study to determine which types of heart failure patients had longer hospital stays. This is important because length of stay puts a financial burden on the patient and hospital. 

The researchers examined hospital records from 1987 to 2003, for 15,792 women and men, ages 45 to 64 in four US communities. The four communities were located in the states of Maryland, Minnesota, Mississippi and North Carolina.

Patients included in the actual study were those that did not have heart failure before their first hospital stay. The length of hospital stay was calculated using admission and discharge dates. Patients with missing dates were not included in the study. A final sample of 1,300 patients was used.

To figure out what can lead to longer hospital stays, they looked at a patient's life to find: median household income, age, gender, race, education level, hypertension, alcohol use, smoking, Medicaid status, and the Charleson comorbidity index score. The index score is a tool for doctors to use on patients that have more than one medical condition. It is a way to measure their risk of death because of their many conditions.

Researchers found that out of the 1,300 patients that were hospitalized for heart failure, most were male, living in low-income communities, with hypertension and had less than a high school education. The average age was 67 years and 11 percent were on Medicaid. They also looked at the patients that died during their hospital stay and found that most were female, living in a low-income neighborhood, with hypertension, currently smoking and on Medicaid.

Adam Powell, PhD, health economist, President of Payer+Provider Syndicate, and dailyRx Contributing Expert said "This study shows that even after adjusting for income and education, Medicaid patients have somewhat different outcomes than non-Medicaid patients. Namely, the study suggests that Medicaid heart failure patients have a longer average length of stay than their equivalent non-Medicaid peers.

Given that it is very expensive for patients to stay in a hospital, it may be prudent for states to examine whether their Medicaid programs have features that hinder the discharge of patients to less intensive settings. If the Medicaid programs themselves are not, in fact, the cause of the longer lengths of stay, it may be cost effective for the programs to increase their coverage of home care and skilled nursing facility care."

The authors noted that there was some information not included in the records. They do not know how these patients got treatment out-of-hospital. This should be the focus of future research.

“Medicaid recipients and patients with more comorbid disease [more diseases or conditions] may not have the resources for adequate, comprehensive, out-of-hospital management of heart failure symptoms, and may require a longer length of stay due to the need for more care during hospitalization because of more severe heart failure,” authors noted in the study.

This study was published by the Journal for Health Care Quality in May 2012 by the National Association for Healthcare Quality. The study was funded through grants from the National Heart, Lung and Blood Institute. The authors disclosed no conflict of interest.

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Review Date: 
December 7, 2012