Cardiovascular disease (CVD) is the world’s foremost cause of death, accounting for approximately one-third of global deaths (19.8 million) worldwide [1][2]. The Global Burden of Disease (GBD). Of them, more than three-quarters occur in low and middle-income countries. Despite preventive efforts and improvements in medical services, CVDs and related crude cardiovascular mortality are expected to continue to rise, driven by advancing age and a growing number of comorbidities [3][4].

Often, hypertension, diabetes mellitus, and dyslipidemia are the most common cluster, leading to progressive coronary artery disease and heart failure. According to the World Health Organization (WHO), 4 out of 5 people living with hypertension have uncontrolled blood pressure [1]. While diabetes imposes a two-fold increase in cardiovascular mortality, dyslipidemia further compounds these risks [5]. Clinically, these comorbidities, along with advancing age and poor chronic disease management, are blamed for recurrent hospitalizations, complex management and require longer care plans. Length of hospital stay (LoS) is a critical indicator of health system efficiency in planning and responding to these clinical emergencies. In recent years, evidence has begun to identify determinants of prolonged cardiovascular hospitalization. A retrospective analysis in Poland found that female patients with heart failure had longer stays than their male counterparts [6]. Another study in Tanzania reported that older males from rural areas with a severe form of CVD and elevated creatinine levels were more likely to have prolonged LOS [7]. This evidence implies an interaction between socio-economic, biological and clinical factors that influences the duration of hospitalization.

The Middle East and North Africa (MENA) regions bear a disproportionate CVD burden. While GBD analyses provide regional estimates, evidence on hospital LoS determinants in MENA populations remains scarce. In Palestine, CVDs have surpassed other diseases as the leading cause of death, with recent figures showing 1 in 3 deaths are related to CVDs (30.6 %) [8][9]. The WHO survey indicated a very high burden of risk factors among Palestinian with (33.6%) had three or more CVD risk factors. The prevalence of hypertension stands at 20.5% and 40% among adults over 40 years [5][10]. According to the International Diabetes Federation, Diabetes affected 15.5% of adults in 2024. The same report highlighted that 59 % of hypertension cases and 53 % of diabetes cases are uncontrolled due to medicine stockouts and limited primary care follow-up [8][9].

Despite the heavy CVD burden in Palestine, little is known about factors that prolong hospital stays for cardiovascular patients. Understanding the local determinants and predictors of LoS is vital for nursing practice, resource allocation, and patient safety. Therefore, this study seeks to characterize the demographic and clinical profile of patients admitted with cardiovascular presentations at a tertiary hospital in the West Bank and to identify factors associated with prolonged length of stay.

This study provides a comprehensive analysis of hospitalized patients with cardiovascular presentations in the southern West Bank, Palestine. A predominantly male, middle-aged and cohort characterized by high burdens of hypertension, diabetes mellitus and coronary artery disease. These comorbidities mirror global trends in cardiovascular risk factors [2]-[4] and highlight the urgent need for more investment and better integration of chronic disease control, as outlined in the WHO report [8].

Age and male sex were strong predictors of prolonged hospitalization, consistent with prior international cardiovascular literature showing that advancing age and male sex are associated with longer admissions [11][12].Women in this sample were older and had higher comorbidity burden but shorter stays. This contrasts with a recent report [6] which demonstrated longer hospitalizations, potentially related to cardiometabolic and hormonal influences [13].

The prevalence of hypertension and diabetes in our cohort is higher than global estimates by the leading cardiovascular organization [14], but broadly comparable to reports of cardiovascular cohorts from low‑resource settings [6][7]. Similar to contemporary literature, our findings underscore the negative impact of cardiometabolic comorbidities on healthcare resources, patient outcomes, and complications [15][16]. Diabetes mellitus increased the odds of staying longer than 1 day by 71%, while coronary artery disease increased the odds by 25%. Smoking was also an independent predictor of longer stay, aligning with evidence on the association between smoking and longer LoS, where smoking contributes to vascular inflammation and is clustered with greater cardiovascular burden among patients with prolonged admission [6]. In contrast, heart failure, renal failure, atrial fibrillation, dyslipidemia and peripheral vascular disease were not independently associated with prolonged stay.

The predictive model explained only a modest proportion of the variance in LoS, suggesting that other factors also play important roles. The findings suggest that longer hospitalisation in this patient population is not driven by an isolated acute event, but rather by cumulative cardiometabolic burden and chronic disease complexity [14]. From a clinical and operational perspective, this means a need for more intensive monitoring, prolonged follow-ups, and complex discharge planning. This implies a higher workload and occupancy rate, as well as the need for multidisciplinary coordination in tertiary hospitals operating in resource-constrained settings.

The outcome (LoS) was dichotomised at the median; alternative definitions may yield different effect sizes. It was dichotomised at the median to allow clinically interpretable logistic regression modelling; however, this approach may have reduced information compared with analysing length of stay as a continuous or count outcome. Comorbidities were coded as binary variables; information on severity, treatment, or control (e.g., blood pressure, glucose levels) was unavailable. Missing data were minimal for comorbidities but slightly higher for age and LoS; however, complete‑case analysis is unlikely to introduce significant bias given the large sample.

This retrospective study of 9642 patients with cardiovascular presentations in Palestine identified older age, male sex, hypertension, diabetes mellitus, coronary artery disease, smoking and previous coronary artery bypass grafting as independent predictors of prolonged hospital stay. These findings highlight the importance of comprehensive chronic disease management and lifestyle interventions to reduce hospitalization time. Further prospective, multicentre studies incorporating detailed clinical data are necessary to refine predictive models and develop targeted nursing interventions.

This analysis was retrospective and relied on administrative data, which limited control over variable definitions and data quality. Several limitations warrant consideration. First, the observational design precludes causal inference. Associations between comorbidities and prolonged stay may reflect underlying disease severity or unmeasured confounders. Second, the dataset lacked details on medications, laboratory values, socioeconomic status, and discharge destination, all of which are known to influence LoS. Third, the analysis used the median to define prolonged stay; while sensitivity analyses yielded similar patterns, other definitions may be more clinically meaningful. Fourth, data were obtained from a single centre in Palestine, limiting generalisability. Finally, any variable in the original dataset with missing data that could not be interpreted was excluded.

Ethical approval for this study was obtained from the Institutional Review Board (IRB) of Palestine Ahliya University and the relevant committee of the participating tertiary referral hospital in Hebron, West Bank, Palestine (Approval No. CAMS/CCNA/01/923). Owing to the retrospective nature and the use of anonymized medical records, informed consent was waived. The extracted dataset was handled confidentially, and no identifiable patient information was collected or reported as per the ethical principles outlined in the Declaration of Helsinki.

The author would like to acknowledge the hospital administration and cardiac catheterization department for facilitating access to the dataset. Appreciation is also extended to Palestine Ahliya University for their support.