Prevention of relapse in patients with congestive heart failure: the role of precipitating factors

Abstract

Relapse of congestive heart failure (CHF) frequently occurs and has serious consequences in terms of morbidity, mortality, and health care expenditure. Many studies have investigated the aetiological and prognostic factors of CHF, but there are only limited data on the role of precipitating factors that trigger relapse of CHF. Knowledge of potential precipitating factors may help to optimise treatment and provide guidance for patients with CHF. The literature was reviewed to identify factors that may influence haemodynamic homeostasis in CHF. Precipitating factors that may oVer opportunities for preventing relapse of CHF were selected. Potential precipitating factors are discussed in relation to the pathophysiology of CHF: alcohol, smoking, psychological stress, uncontrolled hypertension, cardiac arrhythmias, myocardial ischaemia, poor treatment compliance, and inappropriate medical treatment. Poor treatment compliance in particular is frequently encountered in patients with CHF. Furthermore, studies of medical treatment under everyday circumstances indicate that some aspects of the management of CHF can be improved. In conclusion, the identification of precipitating factors for relapse of CHF may strongly contribute to optimal treatment. Improvement of treatment compliance and optimalisation of medical treatment may oVer important possibilities to clinicians to reduce the number of relapses in patients with CHF. (Heart 1998;80:432-436) Keywords: congestive heart failure; precipitating factors; prevention There is increasing interest in congestive heart failure (CHF) from both clinicians and researchers. The prevalence of CHF continues to increase despite advances in the treatment of various risk factors for this disease, such as hypertension and coronary artery disease. 1This increase is the result of several medical and demographic developments: an aging population, decreasing mortality of patients with acute myocardial infarction, and improved treatment of patients with angina pectoris and hypertension.2 In addition, survival in patients with CHF has improved since the introduction of angiotensin converting enzyme (ACE) inhibitors.CHF is clinically characterised by periods of remission and exacerbation. Readmission rates of up to 25% within six months after a previous hospital discharge for CHF have been reported in patients older than 65 years.3 4 Relapse of CHF in patients with previously stable compensated heart failure may be caused by deteriorating ventricular function, but several precipitating factors have been suggested. Some precipitating factors can be regarded as potentially preventable. Research on precipitating factors leading to relapses of CHF, however, is scarce.5 6 Nevertheless, timely identification of potential precipitating factors may oVer an important advantage in eVorts to reduce morbidity and the number of hospital admissions attributed to the syndrome of CHF.We conducted a search of the MEDLINE database from 1966 to December 1997 and used lateral references to review the li...

A Comparison of Precipitants and Mortality When Acute Decompensated Heart Failure Occurs in the Community and Hospital Settings

“…The most common precipitants for ADHF found in this study (infection, myocardial ischaemia and tachyarrhythmia) are consistent with those reported elsewhere [10]. Overall, there were few differences between the community and hospital groups, with the exception of admitting diagnosis.…”

Psychological stress and short-term hospitalisations or death in patients with heart failure

“…[9,13,18, 27] Acute stress can also induce myocardial perfusion abnormalities and trigger malignant arrhythmias in HF patients. [17,26,27] Psychological stress has also important indirect effects on factors that increase risk of hospitalization, such as reduced ability to follow complex medication and lifestyle regimens,[11,24] impaired cognitive functioning, and reduced physical activity. [28]…”

“…[7,8] Chronic psychosocial risk factors such as depression and low social support also predict HF clinical outcomes in prospective studies. [9,13] However, the effects of increases in psychological precipitating factors, such as perceived stress[11,12] on short-term hospitalizations and AEs in HF are not well-understood.…”

Clinical service organisation for heart failure

“…In the recent EuroHeart Failure survey, which included 24 countries, 24% of patients admitted with confirmed or suspected heart failure were readmitted to hospital within 12 weeks -heart failure was the principal cause of readmission (20% of readmissions) and contributed to a further 16% of readmissions (Cleland 2003). Studies suggest that many early re-admissions for heart failure are preventable (Feenstra 1998;Michalsen 1998;Vinson 1990). …”