CONGRESS ABSTRACT

Background: Nursing complexity has significant implications for patient outcomes, yet it remains an underexplored factor in cardiovascular care. This study investigates the levels of nursing complexity and their impact on clinical characteristics, survival outcomes, hospital readmissions, and emergency department (ED) visits in hospitalized cardiovascular patients. Methods:  A prospective cohort study was conducted at an Italian university hospital in a cardiovascular department from December 2020 to June 2022. Adult patients with a primary diagnosis of cardiovascular disease, identified using ICD-9-CM codes, were consecutively enrolled. Data included sociodemographic variables (e.g., age, gender), clinical characteristics (comorbidities, length of stay), and nursing-related variables (number of nursing diagnoses within the first 24 hours of admission and total interventions during hospitalization). Patients were followed for 12 months to assess all-cause mortality, hospital readmissions, and ED visits. Latent Class Analysis stratified patients into high and low-nursing complexity groups adjusted for the number of chronic conditions. Kaplan-Meier survival curves evaluated survival outcomes. Results: Among 858 patients, 54.8% were classified as having high nursing complexity. These patients had a mean of 4.20 ± 2.46 nursing diagnoses and 5.89 ± 2.83 nursing interventions, significantly higher (p < 0.001) than the low-complexity group, characterized by 1.13 ± 2.09 nursing diagnoses and 1.33 ± 3.27 nursing interventions. Kaplan-Meier analysis revealed worse survival in the high-complexity group during the 12-month follow-up, with 153 observed events vs. 113.5 expected events, compared to 27 observed events vs. 66.5 expected in the low-complexity group. The log-rank test confirmed a statistically significant group survival disparity (χ² = 43.1; p < 0.001). The high-complexity group also had higher readmission rates (42.5% vs. 31.8%) but fewer ED visits (16.4% vs. 36.6%) compared to the low-complexity group. Conclusions: High nursing complexity is associated to poorer survival outcomes and increased hospital readmissions, despite fewer ED visits. These findings underscore the importance of early identification and tailored care strategies for patients with high nursing complexity to enhance clinical outcomes in cardiovascular care.