Purpose In many Western countries chronic heart failure (CHF) is the single most common cause of prolonged and costly hospital admission in patients over 65 years (Stewart et al 2001). There is limited research on hospital admission for CHF yet anecdotal reports from heart failure specialist nurses (HFSN) suggest service deficiencies. This study explores and describes patients', in advanced stages of CHF, and their carers' experiences during their last hospital admissions for heart failure, and makes recommendations to improve future care delivery.
Methods A study using audio-taped, in-depth interviews with patients in advanced stages of CHF drawn from four of five hospital sites in a West of Scotland health board. Matched patients (n=7) and carers (n=6), meeting study criteria, were identified by HFSN. Informed consent was obtained from all participants with confidentiality and anonymity of interview data provided. All interviews were conducted by the same experienced nurse researcher in the study participants' homes over 6 months in 2008. Qualitative conventional content analysis was used.
Findings All study participants were male aged 56–83 years (SD: 11.6). One had four hospital admissions in the last 6 months while the others two each. Length of the last admission varied between 8 and 28 days (mean: 13.6). Most patients (n=6) had multiple co-morbidities and abnormally high creatinine levels (average 209.6 micromoles/L). Carers estimated time spent in a “caring role” varied from 14-100%. In the interviews three dominant themes emerged; communication, waiting, and emotional dilemma. Communication in the cardiology wards was described more favourably than other wards but was still not in enough detail for most. In avoiding hospital admission the degree of resistance from patients to inform others of increasing CHF symptoms is of concern. Carers felt they lacked opportunities to talk about end of life issues, yet no patient raised this. Patients and their carers waited: to decide if admission to hospital was essential; to receive treatment; for the treatment to work; and finally to go home. Emotional dilemmas constrained both patients and carers, for example patients commonly failed to undertake self care measures yet their carers felt guilty when urging them to comply.
Conclusions and Recommendations The findings reflect the stressful nature of living with and caring for someone with patients in advanced stages of CHF. This research highlights the additional stressful impact of hospital admission. Patients tried to avoid admission to reduce their own stress but this only served to increase anxiety in their carers. Recommendations include improving knowledge about identifying and managing exacerbations of CHF with quick and less stressful processes, which are in common practice. The feasibility of new approaches should be researched.
- chronic heart failure
- hospital admission