Clinical presentation, hospital length of stay, and readmission rate in patients with heart failure with preserved and decreased left ventricular systolic function

Abstract

Background: Congestive heart failure is the leading cause of hospital admissions for adults in the United States. To our knowledge, there are limited data comparing the clinical presentation, hospital length of stay, and readmission in patients with preserved and decreased left ventricular (LV) systolic function. Hypothesis: The goal of the study was to determine whether there are differences in clinical presentation, hospital length of stay, and readmission in patients with preserved (≥50%) and reduced (< 50%) systolic function. Methods: We prospectively evaluated 187 patients admitted with congestive heart failure confirmed by the presence of pulmonary vascular congestion on chest x-ray, and with recent (<6 months) documentation of LV systolic function by two-dimensional echocardiography. History and physical examination findings, patient demographics, comorbidities, discharge medications, and length of hospital stay data were documented. Readmission rate over a 6-month follow-up period was also documented. Results: Of the 187 patients, 130 (70%) patients had an ejection fraction (EF) <50%, and 57 (30%) patients had an EF ≥ 50%. Patients with EF < 50% were more likely to be men (54 vs. 37%, p = 0.03), African Americans (79 vs. 60%, p = 0.007), had a higher prevalence of previous stroke (17 vs. 5%, p = 0.03), and were more likely to carry no medical insurance at the time of admission (14 vs. 2%, p = 0.01) and to be discharged on digoxin (60 vs.30%, p< 0.001). There were no significant differences in symptoms (exertional dyspnea, rest dyspnea, orthopnea, or paroxysmal nocturnal dyspnea), or in physical examination findings (S3, S4, elevated jugular venous pressure, rales, or peripheral edema). According to chest x-ray, patients with EF <50% had more frequent cardiomegaly (88 vs. 72% p = 0.008), but there were no differences in the presence of pleural effusion or pulmonary vascular congestion (p = NS). The mean length of stay was 5.9 and 5.2 days, respectively (p = 0.34). During the 6-month follow-up period, the readmission rates were 33% (43 patients) and 26% (15 patients), respectively (p = 0.36). Conclusion: The clinical presentation, hospital length of stay, and readmission rate for congestive heart failure are similar in patients with preserved and decreased LV systolic function.