Risk factors for prolonged hospitalization in acute decompensated heart failure from the HEROES study

Area of Science:

• Cardiology
• Clinical Medicine
• Health Services Research

Background:

• Acute decompensated heart failure (ADHF) is a leading cause of hospitalization.
• Predicting length of stay (LOS) in ADHF patients is crucial for resource allocation and patient management.
• The HEROES project investigates risk factors and patient stratification in heart failure.

Purpose of the Study:

• To identify clinical, laboratory, functional, and treatment-related factors associated with prolonged hospitalization (LOS > 8 days) in patients with ADHF.
• To differentiate predictors of short versus long hospital stays in this population.
• To inform strategies for personalized management of ADHF patients.

Main Methods:

• Analysis of 562 Caucasian patients admitted for ADHF, categorized by LOS (≤8 days vs. >8 days).
• Collection of sociodemographic, clinical, laboratory, imaging, treatment, and patient-reported health status (KCCQ-12) data.
• Multivariate logistic regression to identify independent predictors of prolonged hospitalization.

Main Results:

• Patients with longer LOS exhibited higher NYHA class, greater comorbidity burden, longer intensive cardiac care unit (ICCU) stays, and higher in-hospital mortality.
• Elevated NT-proBNP, procalcitonin, and creatinine, along with lower hemoglobin, hematocrit, and sodium levels, were associated with longer LOS.
• Independent predictors of prolonged hospitalization included norepinephrine and dopamine treatment, and oral iron therapy. Protective factors included higher KCCQ-12 scores, higher systolic blood pressure on admission, and prior statin use.

Conclusions:

• Prolonged hospitalization in ADHF is associated with more severe heart failure symptoms, higher comorbidity load, impaired functional/laboratory parameters, and longer ICCU stays.
• Norepinephrine, dopamine, and oral iron therapy are predictors of extended hospital stays.
• Higher KCCQ-12 scores, admission systolic blood pressure, and prior statin use are associated with reduced LOS, suggesting potential therapeutic targets.