BACKGROUND: Overall outcomes and the escalation rate for home hospital admissions for heart failure (HF) are not known. We report overall outcomes, predict escalation, and describe care provided after escalation among patients admitted to home hospital for HF. METHODS: Our retrospective analysis included all patients admitted for HF to 2 home hospital programs in Massachusetts between February 2020 and October 2022. Escalation of care was defined as transfer to an inpatient hospital setting (emergency department, inpatient medical unit) for at least 1 overnight stay. Unexpected mortality was defined as mortality excluding those who desired to pass away at home on admission or transitioned to hospice. We performed the least absolute shrinkage and selection operator logistic regression to predict escalation. RESULTS: We included 437 hospitalizations; patients had a median age of 80 (interquartile range, 69–89) years, 58.1% were women, and 64.8% were White. Of the cohort, 29.2% had reduced ejection fraction, 50.9% had chronic kidney disease, and 60.6% had atrial fibrillation. Median admission Get With The Guidelines HF score was 39 (interquartile range, 35–45; 1%–5% predicted inpatient mortality). Escalation occurred in 10.3% of hospitalizations. Thirty-day readmission occurred in 15.1%, 90-day readmission occurred in 33.8%, and 6-month mortality occurred in 11.5%. There was no unexpected mortality during home hospitalization. Patients who experienced escalation had significantly longer median length of stays (19 versus 7.5 days, P <0.001). The most common reason for escalation was progressive renal dysfunction (36.2%). A low mean arterial pressure at the time of admission to home hospital was the most significant predictor of escalation in the least absolute shrinkage and selection operator regression. CONCLUSIONS: About 1 in 10 home hospital patients with HF required escalation; none had unexpected mortality. Patients requiring escalation had longer length of stays. A low mean arterial pressure at the time of admission to home hospital was the most important predictor of escalation of care in the least absolute shrinkage and selection operator logistic regression model.

中文翻译：

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急性失代偿性心力衰竭的家庭医院结局以及与护理升级相关的因素

背景：总体结果和因心力衰竭 (HF) 入院的家庭增长率尚不清楚。我们报告总体结果，预测病情升级，并描述因心衰入院的患者病情升级后提供的护理。 方法：我们的回顾性分析包括 2020 年 2 月至 2022 年 10 月期间因心力衰竭入住马萨诸塞州 2 个家庭医院项目的所有患者。护理升级的定义是转移到住院医院环境（急诊科、住院医疗单位）至少 1 晚住院。意外死亡率被定义为不包括那些希望在入院时在家中去世或转入临终关怀医院的死亡率。我们执行最小绝对收缩和选择算子逻辑回归来预测升级。 结果：我们纳入了 437 例住院治疗；患者的中位年龄为 80 岁（四分位距，69-89）岁，其中 58.1% 为女性，64.8% 为白人。在该队列中，29.2% 的人射血分数降低，50.9% 的人患有慢性肾病，60.6% 的人患有房颤。入院遵守指南 HF 评分中位数为 39（四分位数范围，35-45；预测住院患者死亡率为 1%-5%）。10.3% 的住院治疗情况升级。30 天再入院率为 15.1%，90 天再入院率为 33.8%，6 个月死亡率为 11.5%。在家住院期间没有意外死亡。经历升级的患者的中位住院时间明显更长（19 天 vs 7.5 天，磷<0.001）。升级的最常见原因是进行性肾功能障碍（36.2%）。入院时平均动脉压较低是最小绝对收缩和选择算子回归升级的最显着预测因素。 结论：大约十分之一的家庭医院心力衰竭患者需要升级；没有人出现意外死亡。需要升级的患者住院时间更长。在最小绝对收缩和选择算子逻辑回归模型中，入院时的平均动脉压较低是护理升级的最重要预测因素。