The inpatient experience and predictors of length of stay for patients hospitalized with systolic heart failure: comparison by commercial, Medicaid, and Medicare payer type

Abstract

Objective:

Descriptions of the inpatient experience for patients hospitalized with systolic heart failure (HF) are limited and lack a cross-sectional representation of the US population. While length of stay (LOS) is a primary determinant of resource use and post-discharge events, few models exist for estimating LOS.

Research design and methods:

MarketScan® administrative claims data from 1/1/2005–6/30/2008 were used to select hospitalized patients aged ≥18 years with discharge diagnoses for both HF (primary diagnosis) and systolic HF (any diagnostic position) without prior HF hospitalization or undergoing transplantation.

Results:

Among 17,597 patients with systolic HF; 4109 had commercial; 2118 had Medicaid; and 11,370 had Medicare payer type. Medicaid patients had longer mean LOS (7.1 days) than commercial (6.3 days) or Medicare (6.7 days). In-hospital mortality was highest for patients with Medicaid (2.4%), followed by Medicare (1.3%) and commercial (0.6%). Commercial patients were more likely to receive inpatient procedures. Renal failure, pressure ulcer, malnutrition, a non-circulatory index admission DRG, receipt of a coronary artery bypass procedure or cardiac catheterization, or need for mechanical ventilation during the index admission were associated with increased LOS; receipt of a pacemaker device at index was associated with shorter LOS.

Limitations:

Selection of patients with systolic HF is limited by completeness and accuracy of medical coding, and results may not be generalizable to patients with diastolic HF or to international populations.

Conclusion:

Inpatient care, LOS, and in-hospital survival differ by payer among patients hospitalized with systolic HF, although co-morbidity and inpatient procedures consistently influence LOS across payer types. These findings may refine risk stratification, allowing for targeted intensive inpatient management and/or aggressive transitional care to improve outcomes and increase the efficiency of care.

Keywords::

• Heart failure
• Systolic
• Hospitalization
• Length of stay
• Payer

Transparency

Declaration of funding

Funding for this project was provided by Amgen, Inc.

Declaration of financial/other relationships

LAA was a consultant hired by Amgen and Johnson and Johnson, and has received grant funding from NIH, NHLBI, and K23 of the National Cancer Institute. KST is a former employee of Thompson Reuters, and has received funding from Amgen. KLW and DMS are current employees of Truven Health Analytics, formerly of Thompson Reuters, which was contracted by Amgen to work in collaboration on this study. IA is an employee and stockholder of Amgen, Inc.

The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

We gratefully acknowledge the programming assistance of Kelly Oh and Chandrasekar Balakrishnan of Truven Health Analytics, formerly of Thompson Reuters, and the input on the initial study concept from Matthew Gitlin of Amgen, Inc. and William Padula of University of Colorado, in addition to Michele Shaw of Naples, FL for her medical writing expertise.