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.
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 accessOne-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 American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Correlates of early hospitalization readmission or death in patients with congestive heart failure.Am J Cardiol. 1997; 79: 1640-1644
- Factors influencing knowledge of and adherence to self-care among patients with heart failure.Arch Intern Med. 1999; 159: 1613-1619
- Readmission after hospitalization for congestive heart failure among Medicare beneficiaries.Arch Intern Med. 1997; 157: 99-104
- Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure.Am J Med. 1996; 101: 270-276
- Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure.J Am Coll Cardiol. 1997; 30: 725-732
- Perspective of the pharmaceutical industry on the development of new drugs for heart failure.J Am Coll Cardiol. 1993; 22: 198-200
- Hospital readmissions among the elderly.J Am Geriatr Soc. 1985; 33: 595-601
- Early readmission of elderly patients with congestive heart failure.J Am Geriatr Soc. 1990; 38: 1290-1295
- Quality of care for patients hospitalized with heart failure at academic medical centers.Am Heart J. 1999; 137: 1028-1034
- Quality of care for elderly patients hospitalized with heart failure.Arch Intern Med. 1997; 157: 2242-2247
- Smoking cessation following admission to a coronary care unit.J Gen Intern Med. 1991; 6: 305-311
- Concomitant factors for decompensation in chronic heart failure.Am J Cardiol. 1996; 78: 354-356
- Management of heart failure:counseling, education and lifestyle modifications.JAMA. 1994; 272: 1442-1446
- Prevention of relapse in patients with congestive heart failure.Heart. 1998; 80: 432-436
- Alcohol and congestive heart failure.Alcohol Clin Exp Res. 1998; 22: 315S-317S
- Factors influencing knowledge of and adherence to self-care among patients with heart failure.Arch Intern Med. 1999; 150: 1613-1619
- Alcohol consumption and heart failure in hypertensives.Int J Cardiol. 1996; 53: 81-85
- Psychosocial factors influence control of moderate and severe hypertension.Soc Sci Med. 1983; 17: 773-782
- Effects of spouse support and health beliefs on medication adherence.J Fam Prac. 1983; 17: 837-841
- Prevention of readmission in elderly patients with congestive heart failure.J Gen Intern Med. 1993; 8: 585-590
- Effect of a heart failure program on hospitalization frequency and exercise tolerance.Circulation. 1997; 96: 2842-2848
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.
