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activities of daily living, dyspnea, heart failure, nursing, patient readmission, respiratory sounds



  1. Anderson, Kelley M. PhD, RN, FNP


Background: Heart failure is a clinical syndrome that incurs a high prevalence, mortality, morbidity, and economic burden in our society. Patients with heart failure may experience hospitalization because of an acute exacerbation of their condition. Recurrent hospitalizations soon after discharge are an unfortunate occurrence in this patient population.


Objective: The purpose of this study was to explore the clinical and diagnostic characteristics of individuals hospitalized with a primary diagnosis of heart failure at the time of discharge and to compare the association of these indicators in individuals who did and did not experience a heart failure hospitalization within 60 days of the index stay.


Methods: The study is a descriptive, correlational, quantitative study using a retrospective review of 134 individuals discharged with a primary diagnosis of heart failure. Records were reviewed for sociodemographic characteristics, health histories, clinical assessment findings, and diagnostic information.


Results: Significant predictors of 60-day heart failure readmissions were dyspnea ([beta] = 0.579), crackles ([beta] = 1.688), and assistance with activities of daily living ([beta] = 2.328), independent of age, gender, and multiple other factors. By using hierarchical logistical regression, a model was derived that demonstrated the ability to correctly classify 77.4% of the cohort, 78.2% of those who did have a readmission (sensitivity of the prediction), and 76.7% of the subjects in whom the predicted event, readmission, did not occur (specificity of the prediction).


Conclusion: Hospitalizations for heart failure are markers of clinical instability. Future events after hospitalization are common in this patient population, and this study provides a novel understanding of clinical characteristics at the time of discharge that are associated with future outcomes, specifically 60-day heart failure readmissions. A consideration of these characteristics provides an additional perspective to guide clinical decision making and the evaluation of discharge readiness.