Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Sarwat I. Chaudhry

Subject Area(s)

Medicine

Abstract

Heart failure (HF) is one of the most common reasons for hospitalization and the leading

cause of 30-day readmissions. There is great interest in developing strategies to reduce

hospital utilization in this large and growing patient population. Aside from classic heart

failure symptoms of dyspnea and fatigue, other symptoms reported include decreased

appetite, pain and anxiety. These symptoms may be amenable to treatment and patients hospitalized with heart failure may benefit from intensive symptom management in the

form of palliative care. There is limited data in the heart failure population about symptom burden both during hospitalization and shortly after hospital discharge, as well

as patients' perceptions of palliative care. Therefore, our aim was to evaluate if patients discharged from the hospital after acute decompensated heart failure exhibit a high

burden of residual symptoms one week post-discharge. Patients hospitalized for heart failure were enrolled in this prospective cohort study. Patients were interviewed about symptom burden using the Edmonton Symptom Assessment System (ESAS) and Patient Health Questionnaire (PHQ-8) during the hospital admission and 7 to 10 days post- discharge. Patients were also questioned about existing knowledge of palliative care, and then - after a brief, standardized explanation of the goals of palliative care - patients were queried about their interest in receiving palliative care services. Ninety-one patients were enrolled; their mean age was 71.5 years (SD 12.6 years) 51.6% were female and 74.5% had NYHA class III/IV heart failure. Symptoms frequently reported during the baseline interview included decreased wellbeing (94.1%), fatigue (85.9%), shortness of breath (81.2%), anxiety (62.4%) and pain (47.1%). Frequent symptoms reported in the follow- up interview were decreased wellbeing (95.3%), fatigue (88.2%) and shortness of breath (84.7%), anxiety (60.0%) and pain (55.3%). While only 22.4% of patients had heard of `palliative care,' after a standardized explanation, 68.2% were interested in receiving palliative care services while hospitalized. Patients hospitalized for heart failure experience a high burden of symptoms, including not only those usually associated with heart failure such as dyspnea and fatigue, but also anxiety and pain. These symptoms are common during hospitalization and the majority of patients appear to experience troublesome symptoms shortly after discharge as well. Given that patients' symptoms frequently drive health care utilization, integration of palliative care into routine heart failure management is a promising strategy to reduce readmission after heart failure hospitalization.

Comments

This is an Open Access Thesis.

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