Factors Participating in Readmission of Heart Failure Patient, and Hospital Burden in Karachi, Pakistan

DOI: 10.5083ejcm20424884.168 , Cite or Link Using DOI
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Abdul Mueed, Syed Haseeb Raza, Sajid Ali Shiekh, Zubair Mumtaz, Faisal Khanzada, Han Naung Tun

Background: Heart failure (HF) is one of the leading causes of hospitalization and readmission among older adults. Chronic heart failure (CHF) is the most common cause of readmission among patients in Pakistan and worldwide. Despite this recent attention to HF readmission, we know relatively little about its actual causes despite the fact that patients themselves can identify the underlying factors that contribute to their readmissions. Objective: To systematically investigate the patients’ perspectives about the reasons for their hospital readmission in stabilized discharged HF patients and to study how to improve our heart failure care system to reduce the number of readmission in cost effective way. Methods: This qualitative study, using in- depth semi-structured patient interviews, was conducted among patients readmitted to National Institute of Cardiovascular Diseases, through emergency in Karachi, Pakistan for a period of 3 months from June 2019 till august 2019. Patients readmitted within 6 months of their discharge after primary HF were included in the study. Patients were approached, consented, and interviewed within the next 24 hours of readmission. Results: During the readmission, median length of stay was 6 days. Among the 500 patients included in the study, 375 (75%) were males, the commonest cause of heart failure was ischemic cardiomyopathy in 400 (80%) cases. Common reason for readmission was lack of counseling (40%), followed by under dose (15%), non-compliance (12%), and volume over load (10%), hypertension (10%) and secondary infection (7%). No deaths were recorded. Conclusion: We conclude that, along with patient compliance of medication, appropriate fluid intake, self-care and life style modification, psychotherapies and proper counseling sessions can help reduce the readmissions due to HF. Detailed case records must be maintained by the physicians at the time of diagnosis of such patients.