CONGRESS ABSTRACT

Background: Frailty, a multidimensional condition, poses significant challenges in heart failure (HF) patients, frequently leading to increased nursing complexity and prolonged hospital length of stay (LOS). This study aims to investigate the association between frailty and nursing complexity, as well as their combined influence on hospital length of stay (LOS) in HF patients. Methods: A retrospective observational study was conducted at an Italian university hospital, including all patients with HF admitted consecutively over one year. Frailty was measured using the Blaylock Risk Assessment Screening Score (BRASS), classifying patients into low (score <10), moderate (score 10–19), and high (score ≥20) risk categories. Nursing complexity was measured using the Nursing Dependency Index (NDI), defined as the number of nursing diagnoses per patient on hospital admission. Prolonged LOS was defined as stays exceeding the 75th percentile. Data were collected using the hospital discharge register and the Professional Assessment Instrument, a system designed to record nursing care. Pearson correlation analyses were conducted to explore relationships between variables. Latent Class Analysis (LCA) identified nursing complexity and frailty profiles, while logistic regression evaluated associations between LCA profiles and prolonged LOS. Results: Among 608 patients (mean age 75.7 ± 13.06), the mean NDI score was 4.31 ± 3.44, and the mean BRASS score was 8.01 ± 6.00. The NDI increased significantly with frailty risk (low: 3.96 ± 3.34; moderate: 5.46 ± 3.71; high: 5.31 ± 3.00; F = 10.212, p < 0.001). Correlations were observed between NDI and frailty (r = 0.213, p < 0.001), NDI and LOS (r = 0.127, p < 0.005), and frailty and LOS (r = 0.179, p < 0.001). LCA identified two profiles: low complexity/low frailty (NDI: 3.62 ± 3.06, BRASS: 6.39 ± 4.50) and high complexity/high frailty (NDI: 6.92 ± 3.58, BRASS: 14.1 ± 6.96). Model fit indices indicated an acceptable fit (log-likelihood = -3193, AIC = 6585, BIC = 7021, and entropy = 0.726), demonstrating good class separation. Logistic regression showed that the high complexity/high frailty profile increased the odds of prolonged LOS by 87% (OR = 1.867, 95% CI: 1.225–2.846, p < 0.005). Conclusion: Higher nursing complexity and frailty are strongly associated with prolonged LOS in HF patients. Identifying distinct profiles of complexity and frailty can guide tailored interventions to improve outcomes and optimize resource use.