Key result
Higher heart failure self-care maintenance scores predict a ~9% higher rate of all-cause readmissions.
Why the study?
Heart failure self-care may reduce readmission rates, while hospitalizations may also affect self-care, but the longitudinal relationships between them remained to be tested.
Does better heart failure self-care reduce all-cause hospital readmissions in patients with heart failure?
Cohort (n=400)
No
Does better heart failure self-care reduce all-cause hospital readmissions in patients with heart failure?
Hazard Ratio: 1.09 (95% CI 1.01–1.17)
p-value: p=< .01
Higher self-care maintenance scores in heart failure patients were paradoxically associated with increased all-cause readmissions, though readmissions themselves motivated improved self-care.
Higher self-care scores were associated with more readmissions; leaves open reverse causation and whether self-care truly lowers events in heart failure.
BACKGROUND: Many patients with heart failure (HF) are repeatedly hospitalized. Heart failure self-care may reduce readmission rates. Hospitalizations may also affect self-care. OBJECTIVE: The purpose of this secondary analysis was to test the hypotheses that better HF self-care is associated with a lower rate of all-cause readmissions and that readmissions motivate patients to improve their self-care. METHODS: This was a prospective cohort study of patients with HF (N = 400) who were enrolled during a stay at an urban teaching hospital between 2014 and 2016. The Self-Care of Heart Failure Index v6.2 was administered during the hospital stay, along with other questionnaires, and repeated at 6-month intervals after discharge. All-cause readmissions and deaths were ascertained for 24 months. RESULTS: A total of 333 (83.3%) were readmitted at least once, and 117 (29.3%) of the patients died during the follow-up period. A total of 1581 readmissions were ascertained. Higher Self-Care of Heart Failure Index Maintenance scores predicted more rather than fewer readmissions (adjusted hazard ratio, 1.09; 95% confidence interval, 1.01-1.17; P < .01). Conversely, more readmissions predicted higher Maintenance scores (b = 0.29; 95% confidence interval, 0.02-0.56; P < .05). CONCLUSIONS: These findings do not support the hypothesis that HF self-care maintenance or management helps to reduce the rate of all-cause readmissions, but they do suggest that the experience of multiple readmissions may help to motivate improvements in HF self-care.
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Freedland et al. (2023) conducted a cohort in Heart failure (n=400). Heart failure self-care (Self-Care of Heart Failure Index Maintenance scores) was evaluated on All-cause readmissions (adjusted HR 1.09, 95% CI 1.01-1.17, p=< .01). Higher heart failure self-care maintenance scores predicted an increased rate of all-cause readmissions (adjusted HR 1.09; 95% CI 1.01-1.17; P<0.01).
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