Persistent Heart Failure Symptoms at Hospital Discharge Predicts 30-Day Clinical Events

Abstract

Introduction The relationship between heart failure (HF) symptoms at discharge and 30-day clinical events is unknown. Persistent symptoms at discharge are common and approximately 25% of patients are readmitted within 30 days. Variability in assessment of HF symptoms at discharge may affect capacity to predict readmission risk. Objective To describe symptom burden and symptom profiles of HF patients at hospital discharge. A secondary aim was to examine the relationship between symptom burden at hospital discharge and 30-day clinical event rate. Methods An exploratory descriptive design was used. HF patients (n=129) preparing for hospital discharge were enrolled 24-48 hours pre-hospital discharge. The Heart Failure Somatic Perception Scale (HFSPS) assesses 18 physical signs and symptoms of HF on a range of 0 (I did not have this symptom) to 5 (extremely bothersome). The Patient Health Questionnaire-9 (PHQ-9) was used to measure depressive symptoms. Self-Assessed Health (SAH) and comorbid illnesses were documented. Participants were called 30 days post-discharge to assess clinical event rates. HFSPS scores were divided into tertiles (0-10; 11-19; 20 and higher) to explore symptom burden in a subgroup analysis. Results were analyzed using descriptive statistics, chi-square and logistic regression. Results The sample (n=129) was predominantly Caucasian (87.6%), male (63%), elderly (M=73.6, SD=12.6) and symptomatic (94.6%) at discharge. HFSPS scores ranged 0 to 53, M=15.8 (SD 10.6). Hypertension, hyperlipidemia and diabetes were the most common comorbid illnesses. The most bothersome symptoms at discharge were fatigue (71%), nocturia (66%), need to rest more than usual (61%), and inability to do usual activities due to shortness of breath (61%). Thirty-day readmission rate was 28.7% overall with significant differences between HFSPS groups (43.2% and 40.5% of readmissions occurred in second and third tertiles respectively χ2 (2, N\u202f=\u202f129)\u202f=\u202f7.85, p=0.02). HFSPS and SAH were significant predictors of readmission with increased likelihood of readmission by OR 3.9 (p=0.02) and OR 2.97 (p=0.02) respectively. PHQ9 scores were not significant predictors of readmission in this sample. Conclusions The majority of patients in this sample had persistent and bothersome symptoms at hospital discharge that predicted likelihood of 30-day readmission. Comprehensive symptom assessment of HF patients at time of discharge is important and may guide care to decrease 30-day clinical events.