Causes of heart failure exacerbation leading to hospital admission : a cross-sectional study

Background and Objective: Heart failure (HF) is a common disease with an estimated prevalence of 0.4 to 2% in Europe. Patients with HF have frequent episodes of exacerbation. Non-compliance to medical and dietary advice is a significant clinical problem as is suboptimal treatment. One example of factors influencing the ability to comply with a treatment plan is impaired comprehension. The objectives were to construct a medication assessment tool and to establish face validity for its use in this project, to construct an interview schedule in order to identify non-compliance, poor patient comprehension and suboptimal treatment, to conduct a survey and to report the findings to the clinic. Design: A cross-sectional study performed during April 2007–May 2007. Setting: The emergency department and medical wards at Malmö University Hospital. Main Outcome Measures: Comparison of compliance, comprehension and optimal treatment on a population basis between men and women, younger (75 years) patients, and patients in different New York Heart Association (NYHA) classes, in order to assess if exacerbation could have been caused by any of these factors. Results: Of the 47 patients included, 60% reported high compliance. In the subgroup analysis, women and elderly patients reported a significant higher compliance than men and younger patients. Comprehension on self-care was poor. Only 30% weighed themselves regularly and 45% did not limit the amount of fluids. No more than 28% reported they would contact a health care provider in case of experiencing more symptoms. Suboptimal treatment was also found to be a great concern with only 47% being treated with angiotensinconverting enzyme inhibitors (ACEI) or angiotensin II receptor blocker (ARB), 66% with beta blockers, and 51% with aldosterone receptor antagonists, but no consideration to other co-morbidities has been taken into account. The majority treated with recommended agents had not achieved target dose as recommended in guidelines. Conclusions: Poor patient compliance and comprehension as well as suboptimal treatment could contribute to HF exacerbation and efforts should be made to improve these factors in order to reduce HF exacerbation.1 page(s