The independent effects of left ventricular ejection fraction on short-term outcomes and resource utilization following hospitalization for heart failure

Background: While depressed left ventricular ejection fraction is clearly associated with poor long-term outcome in heart failure (HF), the effect of ejection fraction on short-term outcomes and resource utilization following hospitalization for HF remains unclear. Hypothesis: We evaluated the independent effect of depressed ejection fraction (less than or equal to 40%) on shea-term outcomes and resource utilization following hospitalization for HF. Methods: The study population included 443 consecutive patients hospitalized for DRG 127 (HF and shock) with known ejection fraction. For each patient, we assessed the hospitalization cost (1995 US$), length of stay, in-hospital mortality, 30-day mortality, and 30-day readmission rates. Results: Despite similar disease severity at admission, patients with ejection fraction less than or equal to 40% (Group 1) had longer length of stay (4.0 vs. 3.7 days; p = 0.03), a tendency toward higher hospitalization cost ($3,054 vs. $2,770; p = 0.08), more readmissions for any cause (0.4 vs. 0.3; p = 0.05) and for HF (0.2 vs. 0.1; p = 0.01), but similar in-hospital (2.5 vs. 2.6%) and 30-day mortality (4.0 vs. 4.6%) compared with patients with ejection fraction >40% (Group 2). In multivariate analyses, Group 1 patients were more likely to have higher than median hospitalization cost [odds ratio (OR) = 1.98; 95% confidence intervals (CI) = 1.02-3.91] and longer than median hospital stay (OR = 1.68; CI=1.083.91); they were also more likely to be readmitted for any cause (OR = 2.07; CI = 1.15-3.78) or for HF (OR = 5.71; CI = 1.64-21.84), and they tended to have a higher 30-day incidence of death or readmission (OR = 1.65; CI = 0.96-2.84). Conclusions: Depressed left ventricular ejection fraction is associated with higher resource utilization and readmission rates following hospitalization for HE Greater focus on patients with depressed ejection fraction may increase cost savings from HF disease management programs.