Determination of factors related to emergency re-referral in patients with heart failure a hospital in Tehran — Iran: a cross-sectional study

Abstract

INTRODUCTION: The re-referral of heart failure patients to the hospital is a significant health problem today and is one of the most costly and preventable events for these patients. The present study aimed to investigate the factors affecting the re-referral of patients with heart failure to the emergency department of Shahid Beheshti University of Medical Sciences in Tehran in 2021. Identifying these factors can lead to the recognition of patients at high risk for re-hospitalization and the design of preventive and effective interventions. MATERIAL AND METHODS: This descriptive-correlational research was performed cross-sectionally. Ninety patients with heart failure who were re-referred to the emergency department of Masih Daneshvari Hospital entered the study. Sampling was done for 6 months from December 2020 to May 2021. Data collection tools included a researcher-made questionnaire and a European self-care questionnaire for heart failure patients, and the New York Heart Association Classification (NYHA) standard for classifying heart failure class. After completing the questionnaires, the collected data were analyzed by SPSS23 software. RESULTS: the results showed that age (the mean age of the participants in the study was 69.9 years), duration of disease (77.8% was six months to four years), body mass index (the mean body mass index was 27.2) (demographic characteristics) dyspnea (78.9%), organs edema (47.8%), shortness of breath (pathological factors), high blood pressure (54.4%), diabetes (25%), chronic obstructive pulmonary disease (11.1%), and ischemic heart disease (3.3%), (background diseases), high creatinine (the mean 1.98), (laboratory findings), not using beta-blockers (18.4%) and not taking angiotensin receptor blockers (18.8%) (pharmacological agents), NYHA criteria (89% were in NYHA class 3 and 4) and self-care levels of heart failure patients (the mean self-care score was 37.4) have a statistically significant association to re-referrals to emergency (p-value < 0.05). CONCLUSIONS: Identify patients with a high risk of hospital re-referral and decrease additional costs imposed on care centers by recognizing the factors influencing the re-referral of patients with heart failure and design preventive and effective interventions. So, it is possible to increase the patient’s self-care level while reducing the number of re-referrals.