Accelerated Early Discharge and Clinical Outcomes in Heart Failure Patients With Cardiac Implantable Electronic Devices - Subanalysis From a Multicenter Cohort Study

Abstract

Background: Previous studies have demonstrated that a shorter hospital stay reduces adverse outcomes in heart failure (HF), primarily in observational study settings. This trend was further emphasized during the COVID-19 pandemic, resulting in case-control study-like results.

Methods and results: A subanalysis was conducted on 239 patients from a Japanese multicenter cohort study (HINODE), encompassing 32 months before and 6 months after pandemic onset. The duration of hospitalization and clinical outcomes were compared between these 2 periods in HF patients who received guideline-directed medical and cardiac implantable electronic device (CIED) therapy. The duration of HF hospitalization was significantly shortened by 41.1% (95% confidence interval [CI] 6.7-62.8%) during the pandemic period (median 13 days; interquartile range [IQR] 6-19 days) compared with the prepandemic period (median 21 days; IQR 12-38 days). Nonetheless, the incidence rate (IR) of outcomes in the pandemic group was similar (ventricular arrhythmia, HF events, HF and cardiac hospitalization) or lower (all-cause hospitalization [IR ratio 0.6; 95% CI 0.4-1.0]) compared with the prepandemic group. The odds ratio of adverse events was also similar between the 2 groups.

Conclusions: A significant reduction in hospitalization duration during the COVID-19 pandemic was associated with similar or improved clinical outcomes for guideline-adherent HF patients. Current hospitalization durations for advanced HF patients are likely unnecessarily long, and efforts to reduce them are warranted.