Despite efforts to improve outcomes in heart failure (HF), readmission rates remain relatively high. Reasons for readmission from different perspectives (patient, caregiver, health care providers) may help to optimize the future management of patients with HF. The aims of this study are to 1) gain insight into reasons for HF readmission from the perspective of patients, caregivers, cardiologists, and HF nurses; 2) examine similarities and differences in perspectives on the reason for an HF readmission, and 3) describe possibilities to prevent an HF readmission from different perspectives.
Methods and Results
Data on reasons for readmission were collected on 173 readmissions. Perspectives of patients, caregivers, cardiologists, and HF nurses were collected by interview and questionnaire. Worsening HF as the sole reason for readmission was reported most often; however, 36% of caregivers, 56% of patients, and 63% to 65% of health care providers indicated that other factors, such as comorbidity, nonadherence, and nonoptimal medication, were important contributing factors. In only 34% of readmissions, patients and their caregivers agreed with health care providers on the underlying reason. Respondents reported that 23% to 31% of the readmissions could probably have been prevented if adherence were higher, patients requested help earlier, and adequate multidisciplinary professional help were available.
To prevent future readmissions of patients with HF, it is important to fully understand the reasons for readmission by gaining insight on the reason for readmission from different perspectives. Also, we may need another approach to prevent adverse outcomes in which other medical problems and new strategies to improve adherence have to be considered.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The burden of heart failure.Eur Heart J Suppl. 2002; 4: D50-D58
- Readmission after hospitalization for congestive heart failure among Medicare beneficiaries.Arch Intern Med. 1997; 175: 99-104
- 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; 25: 1570-1595
- Effect of moderate or intensive disease management program on outcome in patients with heart failure.Arch Intern Med. 2008; 168: 316-324
- Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death.J Am Coll Cardiol. 2005; 45: 1654-1664
- Does increased access to primary care reduce hospital readmissions?.N Engl J Med. 1996; 334: 1441-1447
- When, how and where should we “coach” patients with heart failure: the COACH results in perspective.Eur J Heart Fail. 2008; 10: 331-333
- Evidence based factors in readmission of patients with heart failure.J Nurs Care Qual. 2006; 21: 160-167
- Living with heart failure: partner perspectives.J Cardiovasc Nurs. 2007; 22: 131-137
- The objective burden in partners of heart failure patients: development and initial validation of the Dutch Objective Burden Inventory (DOBI).Eur J Cardovasc Nurs. 2008; 7: 3-9
- Characterization of the precipitants of hospitalization for heart failure decompensation.Am J Crit Care. 1998; 7: 168-174
- Factors contributing to the hospitalization of patients with Congestive Heart Failure.Am J Public Health. 1997; 87: 643-648
- Hospitalization of patients with heart failure.Eur Heart J. 2002; 23: 877-885
- Acute precipitants of congestive heart failure exacerbations.Arch Intern Med. 2001; 161: 2337-2342
- Care management of low-risk patients with heart failure.Ann Intern Med. 2004; 141: 606-613
- Clinical events leading to the progression of heart failure: insights from a national database of hospital discharges.Eur Heart J. 2001; 22: 153-164
- Precipitating factors leading to decompensation of Heart Failure.Arch Intern Med. 1988; 148: 2013-2018
- Preventable causative factors leading to hospital admission with decompensated heart failure.Heart. 1998; 80: 437-441
- Reasons for seeking acute care in chronic heart failure.Eur J Heart Fail. 2007; 9: 702-708
- Early readmission of elderly patients with congestive heart failure.J Am Geriatr Soc. 1990; 38: 1290-1295
- Ungenügende Behandlungsdisziplin, Patienteninformation und Medikamentenverschreibung als Ursachen für die Notfallhospitalisation bei chronisch herzinsuffizienten Patienten.Schweiz Med Wochenschr. 1993; 123: 108-112
- Factors contributing to rehospitalization of elderly patients with heart failure.J Cardiovasc Nurs. 1997; 11: 75-84
- Design and methodology of the COACH study.Eur J Heart Fail. 2004; 6: 227-233
- Non-compliance in patients with heart failure; how can we manage it?.Eur J Heart Fail. 2005; 7: 5-17
- Unravelling the mechanisms for heart failure patients' beliefs about compliance.Heart Lung. 2007; 36: 253-261
- Compliance in heart failure patients: the importance of knowledge and beliefs.Eur Heart J. 2006; 27: 434-440
- Randomised controlled trial of specialists nurse intervention in heart failure.BMJ. 2001; 323: 715-718
- A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure.N Engl J Med. 1995; 333: 1190-1195
- Systematic review of multidisciplinary interventions in heart failure.Heart. 2005; 91: 899-906
- A systematic review of randomized trials of disease management programs in heart failure.Am J Med. 2001; 110: 378-384
Annema C, Luttik ML, Jaarsma T. Do patients with heart failure need a case manager? J Cardiovasc Nurs (in press).
- A systematic review of telemonitoring for the management of heart failure.Eur J Heart Fail. 2003; 5: 583-590
Published online: January 22, 2009
This study was supported by The Netherlands Heart Foundation (Grant 2000Z003).
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.