title: Patients Commonly Believe Their Heart Failure Hospitalizations Are Preventable and Identify Worsening Heart Failure, Nonadherence, and a Knowledge Gap as Reasons for Admission.
abstract: BACKGROUND
  There are few data describing patient-identified precipitants of heart failure (HF) hospitalization. We hypothesized a patient's perception of reason for or preventability of an admission may be related to 30-day readmission rates.
  
  
  RESULTS
  Ninety-four patients admitted with decompensated HF from July 2014 to March 2015 completed a brief questionnaire regarding circumstances leading to admission. Thirty-day outcomes were assessed via telephone call and chart review. Mean age was 58 ± 14 years, with 60% blacks (n = 56) and 41% females (n = 39). Median left ventricular ejection fraction was 30%; 27 had preserved ejection fraction. Seventy-two patients identified their hospitalization to be due to HF (± another condition). Most common patient-identified precipitants of admission were worsening HF (n = 37) and dietary nonadherence (n = 11). Readmitted patients tended to have longer time until first follow-up appointment (21 vs 8 days). Seven of the 42 patients who identified their hospitalization as preventable were readmitted compared with 21/49 who believed their hospitalization was unpreventable (P = .012). On multivariate regression analysis, patients who thought their hospitalization was preventable were less likely to be readmitted (odds ratio 0.31; 95% confidence interval 0.10-0.91; P = .04).
  
  
  CONCLUSIONS
  Almost 50% of patients believe their HF hospitalization is preventable, and these patients appear to be less likely to be readmitted within 30 days. Notably, patients cite nonadherence and lack of knowledge as reasons hospitalizations are preventable. These results lend insight into possible interventions to reduce HF readmissions.
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: naggarw2@jhmi.edu.
authors.forename: Nisha A
authors.initials: NA
authors.lastname: Gilotra
authors.affiliation: Cardiovascular Division, Washington University at St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Adam
authors.initials: A
authors.lastname: Shpigel
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ike S
authors.initials: IS
authors.lastname: Okwuosa
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Ruth
authors.initials: R
authors.lastname: Tamrat
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Flowers
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
mesh_terms: D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Readmission; decompensated heart failure; patient-centric