Characteristics of Saudi patients with congestive heart failure and adherence to management guidelines in a tertiary hospital in Riyadh

Background: Patients who suffer from a stroke are susceptible to multiple complications, with readmission rates ranging from 20-40% per year, and approximately 25% of readmissions occurring within the first month 1 . Major reasons contributing to readmissions include recurrent stroke (24%), infection (12%), chest pain or myocardial infarction (10%), worsening of stroke symptoms (7%), arrhythmias (7%), and congestive heart failure (3%) 2 . However, additional potentially reversible risk factors have not been extensively studied. Methods: This retrospective study was conducted at a tertiary hospital in Singapore and included 1283 patients who were admitted for stroke between Jan 2014 and Oct 2015. All patients who had previous history of stroke or died on initial presentation were excluded from the study, leaving 957 patients with first stroke presentation. The dates and diagnoses of readmissions in the first 90 days were collected. Elective admissions or readmissions due to recurrent strokes or coronary syndromes were excluded to focus on readmissions due to infections, medication side effects, falls, or care coordination issues. Results: Out of 957 patients, 129 (13.4%) were readmitted within 90 days. 98 (10.2%) were readmitted once in 90 days, while 31 (3.2%) were readmitted multiple (2-7) times. The single readmission group showed a bi-modal distribution with 35.7% of readmissions occurring in the first 15 days, 15.3% in 15-30 days, 34.7% in 30-60 days, and 24.5% in 60-90 days after discharge. In the single readmission group, 36.7% of patients were readmitted for infections (15.3% were urinary tract infections, 21.4% were chest infections), 12.2% were admitted for congestive heart failure symptoms, and 17.3% were admitted for falls or care coordination issues. A majority (59%) of readmitted patients were over the age of 70. 24% of the patients had a middle cerebral artery (MCA) stroke, and 34% had a decrease in function of activities of daily living on discharge. Conclusion: This study helps to highlight high risk groups for readmissions i.e. patients over the age of 70 years, reduction in function on discharge, and patients with MCA strokes, suitable for targeted interventions in order to reduce rate of readmissions in patients with first stroke.

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Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age

Clinical Medicine Insights Cardiology ◽

10.1177/1179546818809358 ◽

2018 ◽

Vol 12 ◽

pp. 117954681880935 ◽

Cited By ~ 8

Author(s):

Pupalan Iyngkaran ◽

Danny Liew ◽

Christopher Neil ◽

Andrea Driscoll ◽

Thomas H Marwick ◽

...

Keyword(s):

Heart Failure ◽

New York ◽

Congestive Heart Failure ◽

Heart Association ◽

Multidisciplinary Care ◽

The Elderly ◽

Tertiary Hospital ◽

Chronic Obstructive ◽

Common Denominator ◽

Chronic Renal Impairment

This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.

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