Elsevier

Heart & Lung

Volume 38, Issue 5, September–October 2009, Pages 427-434
Heart & Lung

Issues in heart failure
Reasons for readmission in heart failure: Perspectives of patients, caregivers, cardiologists, and heart failure nurses

https://doi.org/10.1016/j.hrtlng.2008.12.002Get rights and content

Objective

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.

Conclusion

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.

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

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    This study was supported by The Netherlands Heart Foundation (Grant 2000Z003).

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