Discharge timing and associations with outcomes following heart failure hospitalization

To compare all-cause readmission or mortality between patients with heart failure (HF) with discharge ordered before noon (DOBN) and those with discharge ordered after noon (DOAN).

A retrospective multicenter study of 14,469 patients hospitalized for acute decompensated HF at 17 hospitals in 4 US states (admitted January 2010-December 2022 and followed through May 2023).

Patients were grouped by discharge timing: DOBN (00:00-12:00) and DOAN (12:01-23:59). We assessed all-cause readmission or mortality at 7 days, 30 days, and 3 years post discharge.

Of all patients, 2844 (19.7%) were in the DOBN group and 11,625 (80.3%) were in the DOAN group. The DOBN group had higher mortality than the DOAN group at 7 days (2.6% vs 1.3%; HR, 1.39; 95% CI, 1.05-1.86), 30 days (8.9% vs 5.2%; HR, 1.34; 95% CI, 1.15-1.58), and 3 years (50.6% vs 41.4%; HR, 1.13, 95% CI, 1.06-1.21) post discharge. The DOBN group also had a higher readmission rate within 7 days (8.3% vs 6.4%; HR 1.99; 95% CI, 1.61-2.48) post discharge but similar readmission rates to the DOAN group at 30 days (16.0% vs 15.2%; HR, 1.07; 95% CI, 0.97-1.20) and 3 years (48.6% vs 49.7%; HR, 0.96; 95% CI, 0.90-1.02). The differences persisted after categorizing patients into 2 timeline groups (2010-2016 and 2017-2022), with DOBN patients having shorter median times to mortality and readmission than DOAN patients.

In hospitalized patients with HF, DOBN was independently associated with higher all-cause mortality both in the short and long term as well as increased early readmission rates. These findings have implications for discharge policies.