Identification of factors predictive of hospital readmissions for patients with heart failure☆☆☆

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.)