title: Factors contributing to the hospitalization of patients with congestive heart failure.
abstract: OBJECTIVE
  This study identifies acute precipitants of hospitalization and evaluates utilization of angiotension-converting enzyme inhibitors in patients admitted with congestive heart failure.
  
  
  METHODS
  Cross-sectional chart-review study was done of 435 patients admitted nonelectively from February 1993 to February 1994 to an urban university hospital with a complaint of shortness of breath or fatigue and evidence of congestive heart failure.
  
  
  RESULTS
  The most common identifiable abnormalities associated with clinical deterioration prior to admission were acute anginal chest pain (33%), respiratory infection (16%), uncontrolled hypertension with initial systolic blood pressure > or = 180 mm Hg (15%), atrial arrhythmia with heart rate > or = 120 (8%), and noncompliance with medications (15%) or diet (6%); in 34% of patients, no clear cause could be identified. After exclusion of those who were already on a different vasodilator or who had relative contraindications, 18 (32%) of the patients with ejection fractions < or = 0.35 measured prior to admission were not taking an angiotensin-converting enzyme inhibitor on presentation to the hospital.
  
  
  CONCLUSIONS
  Interventions to improve compliance, the control of hypertension, and the appropriate use of angiotensin-converting enzyme inhibitors may prevent many hospitalizations of heart-failure patients.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Mass, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Chin
authors.forename: L
authors.initials: L
authors.lastname: Goldman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000150:complications; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006339:Heart Rate; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000150:complications
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors