Preventable causative factors leading to hospital admission with decompensated heart failure

Abstract

Objective-To determine the distribution and importance of various factors, especially the preventable ones, that contribute to cardiac decompensation and subsequent hospital admission for heart failure. Methods-During a one year period patients were prospectively recruited and evaluated during their hospital stay by means of a structured personal interview by trained medical staV and through clinical examination and laboratory investigation. Setting-The cardiological department at a teaching aYliated general community hospital in Berlin, Germany. Patients-Consecutive sample of 179 patients admitted to hospital with acute decompensation of pre-existing heart failure. Main outcome measures-Proportional distribution of causative factors leading to hospital admission for heart failure; relative importance of preventable factors; details of patient compliance with diet and medication, and knowledge about medication. Results-Mean (SD) age was 75.4 (9.9) years. Potential causative factors for decompensated heart failure were identified in 85.5% of patients. Lack of adherence to the medical regimen was the most commonly identified factor and was regarded as the cause of the cardiac decompensation in 41.9% of cases. Non-compliance with drugs was found in 23.5% of patients. Other factors related to hospital admission were coronary ischaemia (13.4%), cardiac arrhythmias (6.1%), uncontrolled hypertension (5.6%), and inadequate preadmission treatment (12.3%). In all, 54.2% of admissions could be regarded as preventable. Conclusions-Many hospital admissions for decompensation of chronic heart failure in patients at a district hospital in Berlin are preventable. Measures are necessary to improve this situation and evaluation of programmes that include patient education, patient follow up, and physician training is needed. (Heart 1998;80:437-441)

A story of maladies, misconceptions and mishaps: effective management of heart failure

“…Important physician factors that may contribute to CHF exacerbations are under-utilization of established therapy such as ACE inhibitors that can reduce morbidity and mortality, and suboptimal education, including low rates of general and dietary counseling (Smith et al, 1998;CONSENSUS, 1987;SOLVD, 1991;IPRO, 1996). Medication and dietary nonadherence (with sodium restriction), inadequate discharge planning and follow-up, lack of social support and not seeking medical attention promptly when symptoms recur also increase the risk of CHF exacerbations (Ni et al, 1999;Ghali, Kadakia, Cooper, & Ferlinz, 1988;Chin & Goldman, 1997;Vinson, Rich, Sperry, Atul, & McNamara, 1990, Tsuyuki et al, 2001Michalsen, Konig, & Thimme, 1998).…”

The Impact of Pre-existing Heart Failure on Pneumonia Prognosis: Population-based Cohort Study

“…1,2 Patients with heart failure carry a high risk of recurring hospital admissions for decompensated heart failure and cardiovascular events. [3][4][5][6] Acute respiratory tract infection is the main precipitating event for 3-16% of patients hospitalized with decompensated heart failure; [7][8][9] conversely, heart failure is a risk factor for pneumonia. 10 Pneumonia-related mortality rates in general patient populations remain at 10%-15%, increasing with advanced age, 11 and it is plausible that pre-existing heart failure may worsen outcome.…”

Home-Based Intervention in Congestive Heart Failure

“…3,4 Although some hospitalizations for CHF are central to its management, a large proportion are avoidable. 7 With an ageing population of CHF patients in whom hospital readmissions are becoming more frequent, 1,2 there is also an increasing economic imperative to limit hospital activity in favor of less expensive community-based care. 4,8 …”