Persistent Heart Failure Symptoms at Hospital Discharge Predicts 30-Day Clinical Events

Abstract

Background: The relationship between heart failure (HF) symptoms at hospital discharge and 30-day clinical events is unknown. Variability in HF symptom assessment may affect ability to predict readmission risk. Objective: The aim of this study was to describe HF symptom profiles and burden at hospital discharge. A secondary aim was to examine the relationship between symptom burden at discharge and 30-day clinical events. Methods: An exploratory descriptive design was used. Patients with HF (n = 186) were enrolled 24 to 48 hours pre hospital discharge. The HF Somatic Perception Scale quantified 18 HF physical signs and symptoms. Scores were divided into tertiles (0-10, 11-19, and 20 and higher). The Patient Health Questionnaire-9 quantified depressive symptoms. Self-assessed health, comorbid illnesses, and 30-day clinical events were documented. Chi-square and logistic regression were used to examine clinical events. Results: The sample (n = 186) was predominantly White (87.6%), male (59.1%), elderly (mean [SD], 74.2 [12.5]), and symptomatic (92.5%) at discharge. Heart Failure Somatic Perception Scale scores ranged from 0 to 53, with a mean (SD) of 13.7 (10.1). Symptoms reported most frequently were fatigue (67%), nocturia (62%), need to rest (53%), and inability to do usual activities due to shortness of breath (52%). Thirty-day event rate was 28%, with significant differences between Heart Failure Somatic Perception Scale tertiles (9.4% vs 37.7% in the second and third tertiles, respectively; χ 2 (N = 186) = 16.73, P < .001). Heart Failure Somatic Perception Scale tertile 2 or 3 (odds ratio [OR], 5.7; P = .003; and OR, 4.3; P = .021), self-assessed health (OR, 2.6; P = .029), and being in a relationship predicted clinical events. Conclusions: Heart failure symptom burden at discharge predicted 30-day clinical events. Comprehensive symptom assessment is important when determining readmission risk.

Effects of a multidisciplinary management program on symptom burden and medication adherence in heart failure patients with comorbidities: A randomized controlled trial

“…Challenges such as symptom clusters, inadequate symptom-related knowledge, poor assessment skills, and lack of trust in health professionals' expertise and support hinder the management of these complex symptoms [16]. According to the middle-range theory of unpleasant symptoms, certain physiological factors, including comorbidities [17], and psychological factors are associated with symptom burden and management [18]. A higher burden of symptoms impairs daily living activities, QoL, and self-management behaviors in HF patients [19].…”

“…The direct effect of coexisting comorbid conditions in HF on worse clinical outcomes, higher symptom burden, poor medication adherence [1], and its relationship with reduced self-management ability [4,16] shows the vital need for symptom management and medication adherence in HF patients with comorbidities [4,8,12,17]. The significant effect of non-invasive telemonitoring on HF care-related costs, the incidence of acute non-fatal HF events [19], and the impact of telephone-based self-management programs on improving health awareness and symptom recognition is clear [20].…”

Reflecting on 2023 and Looking Forward to 2024 at the Journal of Cardiovascular Nursing

“…5 A hallmark of JCN has been the outstanding research that advances heart failure nursing including landmark heart failure self-care theory, [6][7][8] innovative interventions, [9][10][11] and advances in heart failure symptom science. [12][13][14][15] These articles, along with a collection of heart failure caregiver research, can be found in the special collections section of the JCN website. Cardiovascular nursing research focused on advancing heart failure care is more important than ever.…”