Symptom patterns, duration and responses in newly diagnosed patients with heart failure

Abstract

This study investigated the symptom patterns and duration and associated predictors occurring prior to first heart failure (HF) admission. Data from the Managing Cardiac Function (MACARF) program from January to December 2007 were reviewed in relation to preadmission symptoms and contacts with health professionals. Patients (n = 242) were aged 78.7 years (SD 12 years), male (54%) and married (45%). Patients experienced up to seven symptoms (Mean 2.7, SD 1.4) for a median of 4.47 days (range 1-7) before admission, most commonly increased dyspnoea on exertion (88%), and for the shortest duration chest discomfort. Less than half (48%) contacted a health professional before hospitalization, most often a general practitioner (37%). The duration patients experienced before presenting to hospital was increased if they presented during business hours (beta = 2.68) or the evening (beta = 1.88) (and therefore less from midnight to 8:30 am), or with a change in symptom (beta = 1.4), whereas duration was reduced by chest discomfort (beta = -2.01) and older age (beta = -0.07). There is a significant time window during which patients and health professionals may detect and act on worsening HF symptoms. Newly diagnosed patients with HF need support to recognize and respond to these symptoms to avoid hospital admission.

Association between Residence Location and Pre-Hospital Delay in Patients with Heart Failure

“…The proportion of patients who did not take any action (50.6%) was greater than that evidenced in previous studies, which ranged from 12.8 to 36.3% [6,8,18]. Although our sample patients did not take appropriate actions to relieve symptoms, the pre-hospital delay time before seeking medical care (a median of 72 h) was not significantly longer than that evidenced in previous studies conducted in the United States and Japan, which ranged from a median of 60 h to 124 h [5][6][7][8]. This may be related to the healthcare system in Korea where the entire population is covered by the national health insurance.…”

“…Patients with HF often experience various symptoms before admission, although the most frequently reported symptoms are dyspnea (55.0–93.0%), dyspnea with activity (42.0–92.9%), edema (38.5–64.0%), and fatigue (53.0–84.4%) [ 5 , 6 , 8 , 18 ]. This is consistent with our findings.…”

“…Pre-hospital delay is an essential factor that contributes to rehospitalization. Reportedly, the median time interval between recognizing the worsening of HF symptoms and seeking medical care ranges from 5.3 h to 7 days [ 4 , 5 , 6 , 7 , 8 ].…”

Myocardial infarction patients' learning needs: Perceptions of patients, family members and nurses

“…Patients with cardiovascular disease had low self-management capabilities and symptom and risk factors monitoring. In fact, these abilities are needed for early detection and treatment of worsening disease symptoms and reduce the risk of rehospitalization [7]. Such abilities should have been provided through health information session that should begin when the patient is admitted to the hospital.…”

Expectations and experiences of older people and their carers in relation to emergency department arrival and care: A qualitative study in Australia

“…Negative experiences in the ED may result in an excessive delay in presenting on subsequent occasions, limiting treatment options, and increasing clinical risk. For instance, in contrast to other patients who present when symptoms occur (Thornton et al, 2014), older people may experience severe and potentially lifethreatening symptoms for several days before presenting to the ED (Gallagher et al, 2012). As a consequence of this delay, the ED experience develops into a crisis in which hospital admission becomes the only option.…”