Issues in Cardiovascular NursingIdentification of factors predictive of hospital readmissions for patients with heart failure*,**
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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2019, Heart Lung and Circulation
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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.
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