Elsevier

American Heart Journal

Volume 150, Issue 5, November 2005, Pages 984.e7-984.e13
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Vulnerabilities of patients recovering from an exacerbation of chronic heart failure

https://doi.org/10.1016/j.ahj.2005.07.028Get rights and content

Background

Many rehospitalizations for heart failure (HF) are preventable as they are precipitated by modifiable factors. High early readmission rates suggest that patients commonly are discharged from HF hospitalizations with such problems unaddressed. The purpose of this study was to describe the prevalence of multiple risk factors for rehospitalization in patients recently discharged from a hospitalization for decompensated HF.

Methods and Results

The following potentially modifiable risk factors for rehospitalization were evaluated in 202 patients: functional status; whether the patient lived alone; presence of anxiety, depression, or poor quality of life; and symptom status and adherence to prescribed medications, low-sodium diet, and symptom monitoring recommendations. Most patients were severely functionally impaired (70% New York Heart Association [NYHA] functional class III/IV). Of the 28% of patients who lived alone, 50% were rated as NYHA functional class III or IV. Fifty percent of patients were anxious, whereas 69% of patients were depressed. Health-related quality of life was substantially impaired. Patients reported substantial symptom burden. Adherence with recommended self-care strategies was poor: 14% weighed themselves daily, 9% of patients reported monitoring for symptoms of worsening HF, 31% could not name any symptom, and only 34% of patients taking all medications as prescribed. A total of 23% of patients had all of the following risk factors: NYHA functional class III or IV, lived alone, ≥1 comorbidities, and were depressed or anxious.

Conclusions

Patients newly discharged from a hospitalization for HF exhibit many psychosocial and behavioral risk factors for rehospitalization, although they have been judged clinically stable.

Section snippets

Methods

In this descriptive study, we examined potentially modifiable risk factors among patients with HF enrolled in a randomized controlled trial of a home-based HF disease management intervention. The data reported in this paper were collected at baseline before intervention.

Sample characteristics

A total of 206 patients with HF were enrolled. Four patients dropped from the study before the initial data collection period; thus, the final sample size was 202 (Table I). The sample included patients with both preserved (49%) and nonpreserved systolic function (51%). Most patients (88%) were under the care of a cardiologist during their hospitalization because of a consultation. Medication prescription patterns reflected use of evidence-based medicine (Table II).

Functional status, comorbidities, marital status, and living alone

Most patients were

Discussion

Many health care providers hold the common belief that patients discharged from a hospitalization for an exacerbation of HF have reached an acceptable level of stability. Some investigators have challenged this assumption,20, 21 and findings from the current study indicate that not only are many discharged patients clinically unstable, but also, they are vulnerable to rehospitalization because they have several modifiable risk factors that place them at jeopardy for further decompensation.

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