[Is early discharge possible in patients with uncomplicated heart failure? Cost-efficacy analysis].

Background: Heart failure is a common indication for admission to the hospital among old adults. The hospital stay for uncomplicated heart failure is often too long. We hypothesized that a rapid optimization of care and a guideline-based approach would allow an early discharge of patients, still maintaining a greater quality and efficiency of care.
Methods: We conducted a randomized trial of the effect of a guideline-based intervention on rates of readmission within 90 days of hospital discharge and costs of care for patients who were hospitalized for heart failure and discharged after 4 days of stay. The intervention consisted of early echocardiography, aggressive diuretic therapy, comprehensive education of the patient and family, a prescribed diet, and intensive application of the guidelines' recommendations on pharmacological therapy. Fifty early-discharged patients were compared to 50 concurrent normally-discharged patients.
Results: Average length of stays during baseline admissions was shorter for early-discharged patients respect to controls (3.9 +/- 0.8 vs 7.0 +/- 1.9 days, p < 0.001). At discharge, when compared with control patients, early-discharged patients were similarly prescribed and/or were taking similar dosages of ACE-inhibitors (84 vs 80% and 17 vs 15 mg/die, p = NS), beta-blockers (64 vs 56% and 14 vs 16 mg/die, p = NS), spironolactone (86 vs 70% and 36 vs 32 mg/die, p = NS), digoxin (74 vs 70% and 0.18 vs 0.15 mg/die, p = NS), and losartan (8 vs 6% and 50 mg/die for both groups, p = NS). Hospital readmission rates and days of stay were similar between groups (6 vs 8% and 18 vs 26 days, respectively for study and control patients), whilst the overall costs of care were lower for early-discharged patients (289 vs 449 [symbol: see text] per patient per month), due to the shorter length of stay at baseline. Survival for 90 days was achieved in 47 patients both in the study and control groups (p = NS).
Conclusions: Our study showed that patients admitted for heart failure may be safely discharged 4 days after admission. An in-hospital guideline-based management of patients allows relevant cost savings, reducing hospital readmission for heart failure.