Elsevier

Heart & Lung

Volume 32, Issue 2, March–April 2003, Pages 88-99
Heart & Lung

Issues in Cardiovascular Nursing
Identification of factors predictive of hospital readmissions for patients with heart failure*,**

https://doi.org/10.1067/mhl.2003.15Get rights and content

Abstract

Objective: The objective was to evaluate whether severity of cardiac illness, cognitive functioning, and functional health of older adults with heart failure (HF) and psychosocial factors related to caregiving are predictive of hospital readmissions for those with HF. Design: A prospective, descriptive, predictive design was used. Setting: The study took place in 2 community hospitals in northeastern Ohio. Sample: Originally 156 patient-caregiver dyads were interviewed within 7 to 10 days of hospital discharge, but only 128 dyads completed the study. Subjects had HF and their mean age was 77.3 years. Their caregivers were mostly women with a mean age of 64.8 years. Results: Fourty-four percent of the patients were readmitted to the hospital within 3 months. Among patients, severity of illness was moderate, blood pressure was within normal limits, functional and cognitive status were high. For patients, the interaction of severity of cardiac illness and functional status predicted risk of hospital readmission. Among caregivers, depressive symptoms and perceived stress were low; informal social support and caregiving appraisal were high. The interaction of caregiver stress and depression were significant predictors of risk of hospital readmission. Conclusion: Nurses should consistently assess changes in patients' cardiac symptoms in addition to their ability to provide self-care. Since patients with HF are at high risk for readmission, further study is needed to determine whether interventions designed to increase spousal support would decrease hospital readmissions. (Heart Lung® 2003;32:88-99.)

Section snippets

Background

A diagnosis of HF is complicated by the complex interplay between aging and physical and psychosocial factors affecting patients and their caregivers. The following review addresses findings about HF patients and their caregivers.

Patient factors

Physical factors affecting older adults with HF include symptoms of shortness of breath, edema, fatigue, chest pain, and complications of other chronic health problems.5 Risk factors associated with hospital readmissions for HF are ischemic heart disease, severity of illness, low blood pressure, and a previous hospital admission for HF.6 In a study of a multidisciplinary treatment approach to patients with HF, systolic blood pressure significantly predicted hospital readmission during a 90-day

Caregiver factors

In addition to changes in health, readmission to the hospital may be related to multiple intrapersonal and extrapersonal factors such as caregiver support. In a survey of 178 Medicare-certified home care agencies, stressors related to hospital readmission were acute illness of the patient, lack of caregiver support, and unsuitable home environment.13 Vinson, Rich, Sperry, and McNamara14 found that inadequate social support was a contributing factor in 21% of preventable hospital readmissions.

Design

A prospective, descriptive, predictive design was used to evaluate hospital readmissions for patients with HF, changes in functional status over a 3-month period after hospital discharge, and caregiver stress. This phase of the longitudinal study used data from the first data collection to evaluate a conceptual model composed of factors hypothesized as predictors of hospital readmission during the first 3 months after discharge. The patient's age, gender, physical health status, cognitive

Discussion

Consistent with the findings of other researchers,1, 3, 4 44% of the patients were rehospitalized during the 3-month period. Among patients who were readmitted to the hospital, 64% complained of shortness of breath and 80% complained of fatigue at the first interview. Anecdotal data indicated that another cause of readmission was exacerbation of multiple chronic health problems.

Data immediately post hospital discharge were used for hypotheses testing. Results of hypotheses testing indicated

Conclusion

The readmission rate for patients with HF remains high and the majority of variables measured in this study were not significant predictors of hospital readmissions. However, key predictors that did predict readmission were the interaction of severity of patient cardiac illness and functional status, interaction of caregiver depression and stress, and caregiver informal social support. The mechanisms underlying patient health status deserve further study. Because physical and psychosocial

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    *

    Reprint requests: Karen A. Schwarz, PhD, RN, Associate Professor, College of Nursing, The University of Akron, Mary Gladwin Hall, Akron, OH 44325-3701.

    **

    0147-9563/2003/$30.00 + 0

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