Abstract 18848: Frequent Missed Opportunities to Avert Heart Failure Hospitalization
Background: Although emphasis has been placed on events after discharge for patients with heart failure (HF), reducing hospitalization may also require focus on the route prior to hospitalization. We mapped the timing of worsening symptoms and provider contacts in the weeks leading up to HF hospitalization.
Methods: Scripted interviews were conducted in 100 patients admitted with HF to assess when they recognized worsening symptoms, contacted their provider, and made any medication changes.
Results: Patients recognized worsening symptoms including increased fatigue, lower extremity swelling, and worsening dyspnea on exertion a median of 17.5 days before hospitalization; this prompted contact with a medical provider prior to ED presentation in 74 patients. Initial provider contact occurred a median of 14 days prior to hospitalization and led to medication changes in 48 patients. 52 patients had multiple contacts with ambulatory providers prior to being hospitalized.
Conclusions: Patients hospitalized for HF often contact a physician prior to hospital admission. Many receive pre-hospital interventions, though in our sample, these were insufficient to avert eventual admission. These data demonstrate the potential opportunity to decrease HF admissions by providing more effective intervention and rapid re-evaluation after patients call with worsening symptoms.
- © 2012 by American Heart Association, Inc.