title: Prehospital Delay, Precipitants of Admission, and Length of Stay in Patients With Exacerbation of Heart Failure.
abstract: Factors that precipitate hospitalization for exacerbation of heart failure provide targets for intervention to prevent hospitalizations.
  
  
  
  To describe demographic, clinical, behavioral, and psychosocial factors that precipitate admission for exacerbation of heart failure and assess the relationships between precipitating factors and delay before hospitalization, and between delay time and length of hospital stay.
  
  
  
  All admissions in 12 full months to a tertiary medical center were reviewed if the patient had a discharge code related to heart failure. Data on confirmed admissions for exacerbation of heart failure were included in the study. Electronic and paper medical records were reviewed to identify how long it took patients to seek care after they became aware of signs and symptoms, factors that precipitated exacerbation, and discharge details.
  
  
  
  Exacerbation of heart failure was confirmed in 482 patients. Dyspnea was the most common symptom (92.5% of patients), and 20.3% of patients waited until they were severely dyspneic before seeking treatment. The most common precipitating factor was poor medication adherence. Delay times from symptom awareness to seeking treatment were shorter in patients who had a recent change in medicine for heart failure, renal failure, or poor medication adherence and longer in patients with depressive symptoms and hypertension.
  
  
  
  Depressive symptoms, recent change in heart failure medicine, renal failure, poor medication adherence, and hypertension are risk factors for hospitalizations for exacerbation of heart failure.
authors.affiliation: Jia-Rong Wu is an assistant professor, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina. Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Daejeon, South Korea. Rebecca D. Dekker is an assistant professor, J. Darlene Welsh is an associate professor, and Terry A. Lennie and Debra K. Moser are professors, University of Kentucky College of Nursing, Lexington, Kentucky. Eun Kyeung Song is an associate professor, University of Ulsan, College of Nursing, Department of Nursing, Ulsan, South Korea. Demetrius A. Abshire is an assistant professor, Washington State University, College of Nursing, Spokane, Washington. jiarongw@email.unc.edu.
authors.forename: Jia-Rong
authors.initials: JR
authors.lastname: Wu
authors.affiliation: Jia-Rong Wu is an assistant professor, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina. Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Daejeon, South Korea. Rebecca D. Dekker is an assistant professor, J. Darlene Welsh is an associate professor, and Terry A. Lennie and Debra K. Moser are professors, University of Kentucky College of Nursing, Lexington, Kentucky. Eun Kyeung Song is an associate professor, University of Ulsan, College of Nursing, Department of Nursing, Ulsan, South Korea. Demetrius A. Abshire is an assistant professor, Washington State University, College of Nursing, Spokane, Washington.
authors.forename: Kyoung Suk
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Jia-Rong Wu is an assistant professor, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina. Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Daejeon, South Korea. Rebecca D. Dekker is an assistant professor, J. Darlene Welsh is an associate professor, and Terry A. Lennie and Debra K. Moser are professors, University of Kentucky College of Nursing, Lexington, Kentucky. Eun Kyeung Song is an associate professor, University of Ulsan, College of Nursing, Department of Nursing, Ulsan, South Korea. Demetrius A. Abshire is an assistant professor, Washington State University, College of Nursing, Spokane, Washington.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Dekker
authors.affiliation: Jia-Rong Wu is an assistant professor, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina. Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Daejeon, South Korea. Rebecca D. Dekker is an assistant professor, J. Darlene Welsh is an associate professor, and Terry A. Lennie and Debra K. Moser are professors, University of Kentucky College of Nursing, Lexington, Kentucky. Eun Kyeung Song is an associate professor, University of Ulsan, College of Nursing, Department of Nursing, Ulsan, South Korea. Demetrius A. Abshire is an assistant professor, Washington State University, College of Nursing, Spokane, Washington.
authors.forename: J Darlene
authors.initials: JD
authors.lastname: Welsh
authors.affiliation: Jia-Rong Wu is an assistant professor, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina. Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Daejeon, South Korea. Rebecca D. Dekker is an assistant professor, J. Darlene Welsh is an associate professor, and Terry A. Lennie and Debra K. Moser are professors, University of Kentucky College of Nursing, Lexington, Kentucky. Eun Kyeung Song is an associate professor, University of Ulsan, College of Nursing, Department of Nursing, Ulsan, South Korea. Demetrius A. Abshire is an assistant professor, Washington State University, College of Nursing, Spokane, Washington.
authors.forename: Eun Kyeung
authors.initials: EK
authors.lastname: Song
authors.affiliation: Jia-Rong Wu is an assistant professor, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina. Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Daejeon, South Korea. Rebecca D. Dekker is an assistant professor, J. Darlene Welsh is an associate professor, and Terry A. Lennie and Debra K. Moser are professors, University of Kentucky College of Nursing, Lexington, Kentucky. Eun Kyeung Song is an associate professor, University of Ulsan, College of Nursing, Department of Nursing, Ulsan, South Korea. Demetrius A. Abshire is an assistant professor, Washington State University, College of Nursing, Spokane, Washington.
authors.forename: Demetrius A
authors.initials: DA
authors.lastname: Abshire
authors.affiliation: Jia-Rong Wu is an assistant professor, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina. Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Daejeon, South Korea. Rebecca D. Dekker is an assistant professor, J. Darlene Welsh is an associate professor, and Terry A. Lennie and Debra K. Moser are professors, University of Kentucky College of Nursing, Lexington, Kentucky. Eun Kyeung Song is an associate professor, University of Ulsan, College of Nursing, Department of Nursing, Ulsan, South Korea. Demetrius A. Abshire is an assistant professor, Washington State University, College of Nursing, Spokane, Washington.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
authors.affiliation: Jia-Rong Wu is an assistant professor, University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina. Kyoung Suk Lee is an assistant professor, Chungnam National University, College of Nursing, Daejeon, South Korea. Rebecca D. Dekker is an assistant professor, J. Darlene Welsh is an associate professor, and Terry A. Lennie and Debra K. Moser are professors, University of Kentucky College of Nursing, Lexington, Kentucky. Eun Kyeung Song is an associate professor, University of Ulsan, College of Nursing, Department of Nursing, Ulsan, South Korea. Demetrius A. Abshire is an assistant professor, Washington State University, College of Nursing, Spokane, Washington.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology; D004417:Dyspnea / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*