Characterization of the precipitants of hospitalization for heart failure decompensation

Abstract

BACKGROUND: The model for management of patients with heart failure may be a key determinant of morbidity and quality of life. Development of a better management strategy for these patients requires determination of the reasons for decompensation that leads to hospitalization. OBJECTIVES: To ascertain and rank the principal reasons for hospitalization of patients who have heart failure. METHODS: Retrospective audit of all 1992 admissions (N = 1031; 691 patients) coded for heart failure at a Veterans Affairs medical center and a tertiary care university medical center. RESULTS: The diagnosis of heart failure was verified by preset criteria in 72% of the patients. Of the 496 patients with documented heart failure, worsening heart failure was a main reason for admission in 390 (79%). Despite different socioeconomic backgrounds, excessive sodium retention was the leading factor (55%) associated with decompensation in patients at both institutions. Other factors precipitated admission much less often. CONCLUSIONS: Many hospitalizations for heart failure might be avoided by case management directed at lessening sodium overload. Increased use of medications known to be effective in persons with heart failure (angiotensin-converting enzyme inhibitors, digoxin, and adequate diuretic therapy) might reduce the likelihood of decompensation. Implementation of behavioral interventions to assist patients with self-monitoring signs of sodium retention and to improve compliance with medications and dietary sodium restrictions are strategies for further reducing the risk of decompensation.

Seasonal variations in transition, mortality and kidney transplantation among patients with end-stage renal disease in the USA

“…High sympathetic nervous system activity is observed in winter, whereas cutaneous vasodilatation and loss of water and salt from sweating is the suggested mechanism for low blood pressure in summer [6]. The incidence of chronic heart failure, coronary heart disease and stroke are also highest in winter [7][8][9][10][11], and there may be a link between infection and cardiovascular disease through endothelial dysfunction and activation of the inflammatory and coagulation system [12][13][14][15][16][17]. Indeed, previous studies estimated that ∼10-20% of heart failure is attributable to respiratory disease [14][15][16], and another recent study from the USA also confirmed the association of influenza-like illness with cardiovascular mortality [17].…”

Telemonitoring of Heart Failure Patients and Their Caregivers: A Pilot Randomized Controlled Trial

“…In past studies of patients with HF, researchers reported variations in how medications were prescribed and issues with compliance. 39,40 Although patients reported taking medications as prescribed, a formalized monitoring system was not used. Information about dosages or changes in medications was not collected, and these variables could have differed between groups and affected results.…”

Determinants of self‐care decision‐making in hospitalised patients with heart failure

“…Self-care is a natural decision-making process used by patients to improve their health (Riegel et al 2009a,b). Adequate self-care has been related to slowing the deterioration of disease progression, reducing readmissions (Bennett et al 1998, Yancy et al 2013 and improving the quality of life in the patients (Buck et al 2012) and their families (Vellone et al 2013). Helping patients engage in better self-care decision-making, therefore, should be the priority of nursing care.…”