Background & Aims: Heart failure refers to a malfunction of the heart. This disease is actually a clinical syndrome that manifests with shortness of breath (active and at rest), fatigue and weakness, persistent cough or wheezing, and fluid retention. Currently, 64.3 million people worldwide suffer from heart failure. In 2012, 2.4% of Americans had heart failure. Meanwhile, with increasing age, this percentage also increases, so that it reaches nearly 12% of people over 80 years old. Total HF costs (direct and indirect costs) in the US are projected to increase from $30.7 billion in 2012 to $69.8 billion in 2030. Diseases that increase the risk of heart failure include male gender, sleep apnea, diabetes, coronary artery disease, heart valve disease, anemia, high blood pressure, hyperthyroidism, hypothyroidism, and emphysema. Also, people's lifestyle plays a significant role in contracting this disease; smoking, lack of enough exercise, drinking too much alcohol, and being overweight or obese all increase the risk of heart failure. Therefore, among the preventive measures for heart failure, we can mention lifestyle modification and control of the underlying diseases that cause it. The mortality rate in heart failure patients with reduced ejection fraction is higher than those with preserved ejection fraction. Recurrence of the disease after discharge is one of the main challenges in patients with heart failure, which leads to re-hospitalization and a higher mortality rate. Effective and sufficient training for patients to comply with the prescribed drugs is an important part of the treatment of heart failure patients and leads to a reduction in the exacerbation of the disease and re-hospitalization. Non-adherence of patients to drug treatment leads to exacerbation of heart failure, reduced physical performance, high risk of hospitalization, and death.
Among the most important drugs that cause exacerbation of heart failure are non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anesthetics, class 1 antiarrhythmic drugs, some antidiabetic drugs such as pioglitazone, chemotherapy drugs such as anthracyclines. This study aimed to evaluate the risk factors of rehospitalization of patients with heart failure in Tabriz Shahid Madani Heart Hospital during a 6-month period.
Methods: This study is a descriptive-cross-sectional and prospective study that was conducted over a period of 6 months on patients with uncompensated heart failure who were admitted to Shahid Madani Hospital in Tabriz. The amount of the sample is equal to the number of examined patients in the period of 6 months. This study was approved by the ethics committee of the university with the number IR.TBZMED.REC.1400.423 and was conducted based on ethical protocols. The conditions for patients to enter the study include all patients with uncompensated heart failure and a history of hospitalization (at least once) and those over 18 years of age who had completed the ethical consent form. Exclusion criteria include patients' lack of satisfaction, mental disability insufficient understanding of the ethical consent form, and deficiencies in the patients' information. In this study, after evaluating the inclusion and exclusion criteria, eligible patients were included. The clinical information of the patients was recorded in a special data collection form. The first part includes the characteristics and demographic information of the patients (name and surname, file number, sex, age, height, weight, underlying disease history, smoking or drug use, symptoms at the time of visit and family history of cardiovascular diseases). The second part includes the rate of ejection fraction, drugs prescribed in the hospital, drugs prescribed after the last hospitalization, the patient's compliance with the drugs prescribed by the doctor, the history of taking non-prescription drugs, and the history of taking drugs that aggravate heart failure. The third part includes the history of severe activities harmful to the heart, eating salty or fatty foods, drinking a lot of fluids, pregnancy, influenza and coronavirus vaccine injections. Finally, the fourth part includes the patient's routine tests (creatinine, blood cell count, CBC). The source of information included patients' files, drug cardex, laboratory reports, and findings from the patient's history. All the obtained data were entered and analyzed in SPSS software version 23. First, the Kolmogrov-Smirnov test was used to evaluate the normal distribution of the data. T-tests or Mann-Whitney tests were used to compare the mean of continuous data between the two groups. Chi-square tests or Fisher's direct test were also used to compare the mean of non-continuous (ranked) data between two groups. Spearman and Logistic Regression tests were used to check the relationship between the data. In this study, p-values less than 0.05 were considered statistically significant. Descriptive statistics were used to summarize the data including percentage for discrete variables and standard deviation for continuous variables. Parametric data were presented as Mean ± SD.
Results: This study was conducted for 6 months on 112 heart failure patients who were re-hospitalized. The average age of patients is 61.3 ± 12.98 years. In terms of gender, 79.5% (89 people) of patients are men and 20.5% (23 people) are women. The average number of hospitalizations in the studied patients is 6.41 ± 5.89; the minimum hospitalization is 2 times and the maximum hospitalization is 25 times.
The clinical and demographic information of the patients is summarized in Table 1. The average body mass index (BMI) was 26.67 ± 6.73. In terms of underlying diseases, blood pressure with 51 people (45.5%) and diabetes with 41 people (36%) were the most frequent. Also, 43 patients (38.4%) had a history of smoking. Regarding the use of heart failure aggravating drugs, about a quarter of patients used non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.
Based on the Spearman correlation results, the number of readmissions of patients with age (rs = 0.254, p-value = 0.008), pacemaker implantation (rs = 0.287, p-value = 0.002), left ventricular ejection fraction (rs = 0.239, p-value = 0.03), patient compliance with prescribed drugs (rs = 0.222, p-value = 0.021), and cardiac ischemia (rs = 0.394, p-value = 0.001) have a significant relationship (refer to table number 2). Based on the results of linear regression analysis, a cardiac pacemaker with a beta coefficient of 2.3 and p=0.002 is related to the rate of re-hospitalization of patients.
Conclusion: This study showed the risk factors of rehospitalization of patients with heart failure in the largest heart hospital in the northwest of the country. More studies are suggested for more detailed investigations.