PREVENTABLE CAUSATIVE FACTORS LEADING TO HOSPITAL ADMISSION WITH DECOMPENSATED HEART-FAILURE

Objective-To determine the distribution and importance of various fact ors, especially the preventable ones, that contribute to cardiac decom pensation and subsequent hospital admission for heart failure. Methods -During a one year period patients were prospectively recruited and ev aluated during their hospital stay by means of a structured personal i nterview by trained medical staff and through clinical examination and laboratory investigation. Setting-The cardiological department at a t eaching affiliated general community hospital in Berlin, Germany. Pati ents-Consecutive sample of 179 patients admitted to hospital with acut e decompensation of pre-existing heart failure. Main outcome measures- Proportional distribution of causative factors leading to hospital adm ission for heart failure; relative importance of preventable factors; details of patient compliance with diet and medication, and knowledge about medication. Results-Mean (SD) age was 75.4 (9.9) years. Potentia l causative factors for decompensated heart failure were identified in 85.5% of patients. Lack of adherence to the medical regimen was the m ost commonly identified factor and was regarded as the cause of the ca rdiac decompensation in 41.9% of cases. Non-compliance with drugs was found in 23.5% of patients. Other factors related to hospital admissio n were coronary ischaemia (13.4%), cardiac arrhythmias (6.1%), uncontr olled hypertension (5.6%), and inadequate preadmission treatment (12.3 %). In all, 54.2% of admissions could be regarded as preventable. Conc lusions-Many hospital admissions for decompensation of chronic heart f ailure in patients at a district hospital in Berlin are preventable. M easures are necessary to improve this situation and evaluation of prog rammes that include patient education, patient follow up, and physicia n training is needed.