Influence of patient characteristics, use of angiotensin converting enzyme inhibitor, and patient adherence to medications on hospital readmission for congestive heart failure in an inner -city population

Andrew Y Wang, Purdue University

Abstract

The objectives of this study were to evaluate the risks of 90-day hospital readmission for congestive heart failure (CHF) and to identify reasons for patient nonadherence to medications in an inner city population. A computerized hospital discharge data system was used to identify all patients discharged alive with a principal diagnosis of CHF from January 1 through June 30, 1997 at Cook County Hospital, Chicago, IL. Study information was abstracted from medical records for each patient's first admission (index admission) in 1997. Stratified Chi-square, Fisher's exact test, and T-tests were performed for testing statistical differences in readmissions for patients stratified by variables of interest. Stepwise logistic regression analyses were performed for determining independent correlates of readmission in the study sample (Entry criterion P ≤ 0.05, two-tailed). Of 387 patients with a validated diagnosis of CHF, sixty-seven percent of patients were under 65 years old. African Americans accounted for the majority of the study sample (N = 342, 88.4%). Among 320 patients with left ventricular systolic function assessments, sixty-five percent of the patients had LV systolic dysfunction. After adjusting for contraindications, ninety-one percent of patients were on an angiotensin converting enzyme inhibitor at discharge. Nonadherence to medications was the most frequently documented factor for CHF exacerbation (29.2%). A total of 70 (18.1%) patients were readmitted at least once for CHF within 90 days after the index hospitalization. Results of multivariate regression analyses suggested that patients with decreased left ventricular dysfunction, having a prior history of CHF, angina, and nonadherence to prescription medications have significantly increased the risk of 90-day hospital readmission for CHF. The association between ACE inhibitor dosing and readmission was not significant after adjusting for CHF severity, LV systolic function, comorbidities, and contraindications. In conclusion, efforts to ensure that all CHF patients without contraindications receive ACE inhibitors should continue. After adjusting for disease severity no relationship between dose and readmission was evident. However, that may be because doses tended to be on the low side of the recommended dose range. A major lack of medication adherence and evidence of a significantly associated negative outcome indicates that post-discharge follow-up and counseling could be critical in improving patient outcomes.

Degree

Ph.D.

Advisors

Thomas, Purdue University.

Subject Area

Public health

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