FACTORS CONTRIBUTING TO THE HOSPITALIZATION OF PATIENTS WITH CONGESTIVE-HEART-FAILURE

Objectives. This study identifies acute precipitants of hospitalizatio n and evaluates utilization of angiotensin-converting enzyme inhibitor s in patients admitted with congestive heart failure. Methods. Cross-s ectional chart-review study was done of 435 patients admitted nonelect ively from February 1993 to February 1994 to an urban university hospi tal with-a complaint of shortness of breath or fatigue and evidence of congestive heart failure. Results. The most common identifiable abnor malities associated with clinical deterioration prior to admission wer e acute anginal chest pain (33%), respiratory infection (16%), uncontr olled hypertension with initial systolic blood pressure greater than o r equal to 180 mm Hg (15%), atrial arrhythmia with heart rate greater than or equal to 120 (8%), and noncompliance with medications (15%) or diet (6%); in 34% of patients, no clear cause could be identified. Af ter exclusion of those who were already on a different vasodilator or who had relative contraindications; 18 (32%) of the patients with ejec tion-fractions less than or equal to 0.35 measured prior to admission were not taking an angiotensin-converting enzyme inhibitor on presenta tion to the hospital. Conclusions. Interventions to improve compliance , the control of hypertension, and the appropriate use of angiotensin- converting enzyme inhibitors may prevent many hospitalizations of hear t-failure patients.