Abstract
Multiple hospital readmissions for heart failure (HF) are progressively increasing
and may be related to continued tobacco and alcohol use. To study this relation, we
conducted a retrospective chart audit of all veterans discharged with HF at a large
Veterans Administration (VA) facility from 1997 to 1998. Using a multivariate logistic
regression model, the smoking and alcohol use of patients who required >1 HF admission
within 1 year were compared with those who did not. Demographic, clinical, and psychosocial
variables were also included in the model. Of 753 patients admitted with HF during
the review period (mean age 69.1 years, 99% men), 220 patients (29.2%) were readmitted
to the hospital at least once (range 1 to 8 readmissions, mean 1.79 ± 0.27) after
the index admission. In a multivariate analysis, current smoking (odds ratio [OR]
1.82; confidence interval [CI] 1.17 to 2.82) and current alcohol use (OR 5.92; CI
3.83 to 9.13) were independent predictors of readmissions. Other predictors included
living alone (OR 2.09; CI 1.42 to 3.09), HF associated with ischemic etiology (OR
3.99; CI 2.58 to 6.18), higher New York Heart Association class (OR 2.57; CI 1.86
to 3.55), and care provided by a primary care physician compared with a cardiologist
(OR 2.41; CI 1.57 to 3.67). This study confirms that noncompliance to smoking and
alcohol restrictions, which are amenable to change, dramatically increases the risk
for multiple hospital readmissions among patients with HF. Consequently, evaluation
of noncompliance to smoking and alcohol consumption with targeted interventions in
this population may be a key component for the reduction of multiple hospital readmissions.
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Article info
Footnotes
☆This study was supported by a Pre-doctoral Fellowship Award from the American Heart Association, Western States Affiliate, Burlingame, California. Manuscript received March 8, 2000; revised manuscript received and accepted June 21, 2000.
Identification
Copyright
© 2000 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
