Death highest in heart failure patients admitted in January, on Friday, and overnight

May 25, 2013

Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million heart failure admissions over 14 years was presented by Dr David P. Kao (Denver, Colorado).

The Heart Failure Congress 2013 is taking place during 25-28 May in Lisbon, Portugal. The Congress is the main annual meeting of the Heart Failure Association of the European Society of Cardiology.

Identifying peaks in admissions and mortality should assist targeted at higher risk times. Seasonal, weekly and hourly variations have been observed in heart failure admissions but the reasons are unclear. Until now, the relationship of these variations with mortality and length of stay has not been investigated in a single study.

The current study examined the impact of day, month and hour of admission on in- mortality and length of stay in 949,907 hospitalisations for . Data was analysed from all hospitals in the state of New York from 1994 to 2007. A greater number of factors were included in the analysis than ever before so that the researchers could confirm or refute previous theories on the reasons behind variations in heart failure morbidity and mortality (for example substance use).

The researchers found that daily heart failure admissions increased significantly over time (+1.1 admissions/day/year) while in-hospital mortality and length of stay decreased (-0.3%/year and -0.3 days/year, p<0.0001 for all). Dr Kao said: "These findings confirm the huge decline in mortality in hospitals for heart failure over the past 14-15 years following major advances in therapy."

Daily heart failure admissions peaked in February (p<0.0001), while in-hospital mortality (p<0.0001) and length of stay (p=0.01) peaked in January. Mortality and length of stay were lowest for admissions between 06h00-12h00 and highest overnight (18h00-24h00) by a small margin (adjusted OR of death 1.22, p<0.0001). Mortality and length of stay were lowest in patients admitted on Monday (adjusted OR of death 1.09, p<0.001) and highest on Friday (p<0.0001).

Numerous theories have been mooted for the cause of seasonal variations in heart failure morbidity and mortality, for example that the holiday spike is caused by alcohol and drug use. Dr Kao said: "For the first time we've shown that there wasn't a higher rate of alcohol and drug use reported in during December and January, when heart failure mortality was the highest."

Seasonal variations affected rate of heart failure hospitalization and mortality in patients over the age of 30, and the effect was greater with advancing age. An increase in concurrent pneumonia in the winter could impact on heart failure mortality, but there was less seasonal variation in other respiratory diseases like chronic obstructive pulmonary disease (COPD).

The findings suggest that staffing may have an impact on seasonal variations in mortality and length of stay. Dr Kao said: "The fact that patients admitted right before the weekend and in the middle of the night do worse and are in hospital longer suggests that staffing levels may contribute to the findings."

He added: "The seasonal effect on in-hospital death from remained even after controlling for time and weekday of , 17 other medical conditions including , kidney disease, and pneumonia, and demographic factors including gender, ethnicity, and medical coverage status. in morbidity and occur in many diseases, particularly heart disease, and the cold weather itself may have a part to play."

Dr Kao concluded: "Doctors and hospitals need to be more vigilant during these higher risk times and ensure that adequate resources are in place to cope with demand. Patients should be aware that their disease is not the same over the course of the year and they may be at higher risk during the winter. People often avoid coming into hospital during the holidays because of family pressures and a personal desire to stay at home but they may be putting themselves in danger."

Explore further: First drug to improve heart failure mortality in over a decade

Related Stories

First drug to improve heart failure mortality in over a decade

May 25, 2013
Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...

Study finds strong link between income inequality and readmission risk, but not mortality

February 14, 2013
The authors estimate nearly 40,000 extra admissions to hospital as a result of income inequality over the three year study period.

Risk of death, hospital readmission prolonged after heart attack, heart failure

May 16, 2013
Heart attack or heart failure patients may have a high risk of death or re-admission for a month or longer after leaving the hospital, researchers said at the American Heart Association's Quality of Care and Outcomes Scientific ...

Getting fit in middle age can reduce heart failure risk

May 15, 2013
Middle aged and out of shape? It's not too late to get fit—and reduce your risk for heart failure, according to research presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions ...

Drug may improve outcomes after heart attack

March 12, 2013
The prescription drug eplerenone appears to reduce the risk of cardiovascular mortality and heart failure after a heart attack by more than one-third, according to research presented today at the American College of Cardiology's ...

Doctors' decisions on initial hospital admissions may affect readmission rates

May 13, 2011
Researchers compared hospitalization rates and rehospitalization rates of patients admitted for heart attack and for heart failure. Heart attack admissions are considered non-discretionary, whereas, heart failure admissions ...

Recommended for you

Five vascular diseases linked to one common genetic variant

July 27, 2017
Genome-wide association studies have implicated a common genetic variant in chromosome 6p24 in coronary artery disease, as well as four other vascular diseases: migraine headache, cervical artery dissection, fibromuscular ...

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.