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Post-Discharge Outcomes in Heart Failure Are Better for Teaching Hospitals and Weekday Discharges
Study Questions:
What is the impact of teaching status and day of discharge on outcomes after a heart failure hospitalization?
Methods:
The investigators evaluated adults discharged after a heart failure hospitalization between 1999 and 2009, in Alberta, Canada. The primary outcome was death or nonelective readmission 30 days post-discharge.
Results:
Of 12,216 patients discharged from teaching hospitals and 12,157 from nonteaching hospitals, 20,524 (84%) discharges occurred on weekdays. Although they had greater comorbidity and used more health care resources prior to their heart failure hospitalization, patients discharged from teaching hospitals exhibited shorter lengths of stay (adjusted ratio, 0.83; 95% confidence interval [CI], 0.80-0.86) and significantly lower rates of death or readmission in the 30 days after discharge than those discharged from nonteaching hospitals (17.4% vs. 22.1%; adjusted hazard ratio [aHR], 0.83; 95% CI, 0.77-0.89). Patients discharged on weekdays were older and had greater comorbidity, yet exhibited significantly lower rates of death or readmission at 30 days than those discharged on weekends (19.5% vs. 21.1%; aHR, 0.87; 95% CI, 0.80-0.94). Compared to weekend discharge from a nonteaching hospital, 30-day death/readmission rates were lower for weekday discharge from a nonteaching hospital (aHR, 0.85; 95% CI, 0.77-0.94), weekend discharge from a teaching hospital (aHR, 0.80; 95% CI, 0.69-0.92), and weekday discharge from a teaching hospital (aHR, 0.71; 95% CI, 0.63-0.79).
Conclusions:
The authors concluded that patients discharged from teaching hospitals or on weekdays exhibited better outcomes despite having higher risk profiles.
Perspective:
This study reported that discharges from teaching (vs. nonteaching) hospitals and on weekdays (vs. weekends) had higher risk profiles, but were associated with lower crude and adjusted risk of 30-day death or all-cause nonelective readmission. There was a gradient of risk, whereby the adjusted risk was lowest for discharges on weekdays from teaching hospitals and highest for discharges on weekends from nonteaching hospitals. We need to study the structures and processes of care involved in weekday discharges from teaching hospitals to identify key factors that could be emulated by nonteaching hospitals and key processes that need to be included even for weekend discharges in order to optimize outcomes for all patients with HF.
Keywords: Heart Diseases, Cardiology, Canada, Heart Failure, Transcription Factors, Confidence Intervals, Patient Discharge, Hospitalization, Hospitals, Teaching
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