CDC reports CHF hospitalizations rising

Researchers from the Centers for Disease Control and Prevention (CDC) in Atlanta reported a rise in the number of CHF-related hospitalizations between 1985 and 1995 and that the rise will continue unless more preventive programs become available.

The study notes CHF hospitalizations increased from 577,000 to 871,000 as a first-listed diagnosis and 1.7 million to 2.6 million for any diagnosis for heart failure.

"We’ve got to reduce these numbers by reducing risk," says Gail A. Haldeman, MPH, a researcher with the CDC’s Cardiovascular Health Branch. Even before a patient is discharged, there needs to be a plan in place that can assess what the patient will need in order to stay healthy enough not to have to return to the hospital. "Rehospitalization is a real important thing we want to prevent," she says. (See pp. 82-83 for a sample organizer that can help with patient assessment at discharge.)

Before discharge, Haldeman says, caregivers should know the patient’s functional status and what the ejection fraction is, as well as how to assess the support the patient can expect at home.

In her study, she found that not only did hospitalizations increase, but the number of discharges to long-term nursing homes increased as well. This was especially true among female patients, who were discharged to long-term centers in 21% of the cases, compared to 12% for men.

"With women, a lot of the other family members are gone. Lots of women live alone, and they tend to be older [than male CHF patients]. Many are discharged to long-term care because there is no one else at home."

Haldeman notes the intensive home care programs help the patient stay out of the hospital because of the comprehensive education, nursing care, diet support, and medication counseling that often are available. But she notes, if there are other family members available, they also can be very helpful. "Family caregivers have an extremely important role."

Training these caregivers does not have to be very sophisticated, usually focusing on how to look for daily changes in the patient’s weight, blood pressure, and functional status, as well as keep an eye on drug compliance. Any changes should be reported to the patient’s doctor so they can be handled before conditions worsen and the patient needs to be hospitalized again.

That follow-up is important, notes Ann Frantz, RN, a CHF nurse in Pontiac, MI, who recalls how an elderly patient and his wife got his daily weights — but his doctor didn’t tell him what to do once he found he had gained weight. He gained 18 pounds before he went back to his family physician "because he just wasn’t feeling well." It’s those daily changes that need to be recognized and handled before they develop into bigger problems, she says.

Haldeman’s group used National Hospital Discharge Survey data for patients age 35 and older. They found 78% of men and 85% of women hospitalized for CHF were at least 65 years old. This means most of the bill goes to Medicare, she says. Because Medicare would probably have to pay for rehospitalizations, Haldeman says there may be a shift to more support for patients out of the hospital.

Suggested reading

1. Haldeman, GA, et al. Hospitalization of patients with heart failure: National Hospital Discharge Survey, 1985 to 1995. AM Heart J 1999; 137:352-360.