Issues in heart failureReasons for readmission in heart failure: Perspectives of patients, caregivers, cardiologists, and heart failure nurses
Section snippets
Materials and Methods
A descriptive design was used with data from a substudy of the Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure (COACH), a multicenter study on the effects of education and counseling in HF.23 Between November 2002 and February 2005, 1023 patients from 17 Dutch hospitals were included in the COACH study. Inclusion criteria were hospitalization for symptomatic HF, confirmed by the cardiologist, and underlying heart disease as the cause of HF. Exclusion criteria
Clinical and demographic characteristics
In the 1023 patients included in the COACH study, 1161 readmissions occurred during 18 months of follow-up. Of these, 375 readmissions (32%) of 260 patients were related to HF (Fig 1).
Data on reasons for readmission for this substudy were collected on 173 readmissions of 135 patients readmitted for HF. In total, 108 interviews with 83 readmitted patients with HF and 76 interviews with 63 caregivers took place. For practical reasons, not all patients and caregivers could be included in the
Discussion
This is the first study describing different perspectives on the same readmission of a patient with HF. We found that studying the different perspectives of health care providers, patients, and their caregivers adds to the understanding of HF readmissions. On the basis of these insights, relevant interventions for the management of patients with HF can be undertaken to prevent future readmissions. We found that readmissions were perceived as preventable in 23% to 31%. Although this percentage
Limitations
A limitation of this study is that asking opinions, especially related to the question of preventable readmissions, remains a subjective judgment. However, incorporating a different point of view adds to the understanding of HF readmissions and the possibilities to prevent readmissions. By using subjective statements, a potential bias can occur because used categories are not mutually exclusive. Researcher triangulation was used to limit this bias. Although not all patients readmitted for HF in
Conclusions
Within the last decade, an effort has been made to improve outcomes for patients with HF by optimizing treatment and improving adherence and self-care behavior of patients. Despite these efforts, readmission rates for HF remain high. Even in experimental groups of successful HF-management programs, readmission rates for HF were 14% to 29%.27, 28 Our study reported the reasons for readmission from different perspectives. This information can be helpful to further optimize future HF-management
References (32)
- et al.
Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and deathThe Trans-European Network-Home-Care Management System (TEN-HMS) Study
J Am Coll Cardiol
(2005) - et al.
Unravelling the mechanisms for heart failure patients' beliefs about compliance
Heart Lung
(2007) - et al.
A systematic review of randomized trials of disease management programs in heart failure
Am J Med
(2001) - et al.
The burden of heart failure
Eur Heart J Suppl
(2002) - et al.
Readmission after hospitalization for congestive heart failure among Medicare beneficiaries
Arch Intern Med
(1997) - et al.
The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports
Eur Heart J
(2004) - et al.
Effect of moderate or intensive disease management program on outcome in patients with heart failureCoordinating study evaluating Outcomes of Advising and Counseling in Heart failure (COACH)
Arch Intern Med
(2008) - et al.
Does increased access to primary care reduce hospital readmissions?
N Engl J Med
(1996) - et al.
When, how and where should we “coach” patients with heart failure: the COACH results in perspective
Eur J Heart Fail
(2008) - et al.
Evidence based factors in readmission of patients with heart failure
J Nurs Care Qual
(2006)
Living with heart failure: partner perspectives
J Cardiovasc Nurs
The objective burden in partners of heart failure patients: development and initial validation of the Dutch Objective Burden Inventory (DOBI)
Eur J Cardovasc Nurs
Characterization of the precipitants of hospitalization for heart failure decompensation
Am J Crit Care
Factors contributing to the hospitalization of patients with Congestive Heart Failure
Am J Public Health
Hospitalization of patients with heart failure
Eur Heart J
Acute precipitants of congestive heart failure exacerbations
Arch Intern Med
Cited by (130)
Reasons for Hospitalization while Receiving Dementia Care Coordination through Maximizing Independence at Home
2022, Journal of the American Medical Directors AssociationEffects of self-management interventions on heart failure: Systematic review and meta-analysis of randomized controlled trials – Reprint
2021, International Journal of Nursing StudiesEffects of self-management interventions on heart failure: Systematic review and meta-analysis of randomized controlled trials
2020, International Journal of Nursing StudiesEvaluation of the effectiveness of the healthy heart tracker on heart failure self-care
2019, Patient Education and Counseling
This study was supported by The Netherlands Heart Foundation (Grant 2000Z003).