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Heart Failure Patients ‘Bounce Back’ to ED for Non-Medical Reasons

NASHVILLE – Not all of the issues that send acute heart failure patients back to the emergency department are strictly medical.

Often, patients are discharged from the hospital but find that they are unable to care for themselves. The result can be an exacerbation of their condition and a return to the ED.

A study published recently in Annals of Emergency Medicine says a new tool “holds promise” for improving patient outcomes and reducing hospital re-admissions. The tool is designed to assess what interferes with acute heart failure patients' ability to care for themselves after hospital discharge.

"In order to reduce the number of patients returning to the emergency department for heart failure exacerbations, we need a better handle on what they can and cannot do for themselves after hospital discharge and why," said lead author Richard Holden, PhD, of Indiana University. "More than three-quarters of acute heart failure patients in the ER are experiencing exacerbation of their condition, not something new. Many of those exacerbations are the result of self-care challenges, including inadequate access to medications or lack of knowledge, which theoretically can be modified for the better."

Holden and his research team based the report on a survey of 31 acute heart failure patients who visited the ED. Of 47 different self-care barriers – such as transportation problems, insurance problems and caregiver responsibilities – an average of 15 per patient were indicated as sometimes or often present. In fact, at least 25% of patients reported 33 of the barriers.

The 10 most common included the following:

  • Co-morbidities
  • Physical disability
  • Degree of sickness
  • Feeling frustrated
  • Knowledge about disease
  • Functional limitations
  • Memory and attention deficits
  • Special occasions (minor disruptions)
  • Lack of control
  • Disruptions (major disruptions)

Also frequently mentioned were weather, physical obstacles and a food culture incompatible with dietary restrictions.

The article noted that some barriers compounded each other, such as a patient who was sick herself but taking care of others while working full time, leaving little opportunity for self-care.

"The first step in addressing these barriers is to develop a focused, valid and feasible measurement instrument for self-care barriers in the ER," Holden said. "The social determinants of health, along with factors such as poverty and a lack of transportation, must be addressed in order to improve the ER bounce-back rate for acute heart failure patients."

Study authors conclude that an instrument assessing self-care barriers from multiple system sources “can be feasibly implemented in the ED. Further research is required to modify the instrument for widespread use and evaluate its implementation across institutions and cultural contexts. Self-care barriers measurement can be one component of broader inquiry into the distributed health-related ‘work’ activity of patients, caregivers, and clinicians.”