Causes of heart failure exacerbation leading to hospital admission: a cross-sectional study

Background and Objective: Heart failure (HF) is a common disease with an estimated prevalence of 0.4 to 2% in Europe. Patients with HF have frequent episodes of exacerbation. Non-compliance to medical and dietary advice is a significant clinical problem as is suboptimal treatment. One example of factors influencing the ability to comply with a treatment plan is impaired comprehension. The objectives were to construct a medication assessment tool and to establish face validity for its use in this project, to construct an interview schedule in order to identify non-compliance, poor patient comprehension and suboptimal treatment, to conduct a survey and to report the findings to the clinic. Design: A cross-sectional study performed during April 2007–May 2007. Setting: The emergency department and medical wards at Malmö University Hospital. Main Outcome Measures: Comparison of compliance, comprehension and optimal treatment on a population basis between men and women, younger (<75 years) and elderly (>75 years) patients, and patients in different New York Heart Association (NYHA) classes, in order to assess if exacerbation could have been caused by any of these factors. Results: Of the 47 patients included, 60% reported high compliance. In the subgroup analysis, women and elderly patients reported a significant higher compliance than men and younger patients. Comprehension on self-care was poor. Only 30% weighed themselves regularly and 45% did not limit the amount of fluids. No more than 28% reported they would contact a health care provider in case of experiencing more symptoms. Suboptimal treatment was also found to be a great concern with only 47% being treated with angiotensinconverting enzyme inhibitors (ACEI) or angiotensin II receptor blocker (ARB), 66% with beta blockers, and 51% with aldosterone receptor antagonists, but no consideration to other co-morbidities has been taken into account. The majority treated with recommended agents had not achieved target dose as recommended in guidelines. Conclusions: Poor patient compliance and comprehension as well as suboptimal treatment could contribute to HF exacerbation and efforts should be made to improve these factors in order to reduce HF exacerbation.