Abstract 18986: Heart Failure Admissions Under Observation versus Short Inpatient Stay: A Cohort Study

Background: Many patients with heart failure (HF) are admitted for decongestion and have an unpredictable response to therapy. Based on the current practice, patients get admitted either under observation or inpatient stays, a designation which may be more reflective of administrative practices than patient status. We sought to understand the outcomes of patients admitted under observation vs inpatient status who remained in-hospital for less than 2 days. Methods: From 2008 through 2015, our multi-site health system saw 21,339 patients totaling 52,493 admissions with a primary diagnosis of HF. Patients were excluded if they underwent cardiac surgery (n=611), heart transplant (n=187), LVAD (n=198), or if they died during hospitalization (n=1839). Of the remaining 50,654 discharges, two groups were identified; group I (admitted under inpatient status, discharged within 2 days) and group II (admitted under observation). Outcomes were HF readmission, all-cause readmission and all-cause mortality within 1 year of discharge. Results: 8,709 admissions (17%) under inpatient status resulted in discharge within 2 days; 2,648 admissions (5%) were designated under observation. HF readmission rate at 1 year was 55.3% in group I vs 66.5% in group II; HR 0.75 (95% CI 0.71-0.80), p Conclusion: Patients admitted with inpatient status who are discharged within 2 days had lower readmission rates and equivalent mortality to patients admitted for observation, suggesting that the difference between these groups is more administrative designation than reflection of patient status at time of admission. A revised treatment-based algorithm and admission rules are needed to guide physicians and shape healthcare policy.