Coronary artery, renal, and pulmonary disease predictive of multiple hospital admissions for patients with congestive heart failure

Erin J. Madriago, Larry Baker, Jessica Kattan, Melanie Childers, Ezra Amsterdam

Research output: Contribution to journalArticle

Abstract

Patients (PTS) with congestive heart failure (CHF) are a major concern for the health care commurity with increased hospitalizations and resource utilization. To better understand this important patient population, we evaluated PTS at a major teaching institution who admitted for the principle diagnosis of CHF over a 3.5 year period of time. The study group was comprised of 449 PTS: 248 men (63 yr, 21-95) and 201 women (68 yr, 33-103) who caused 994 admits. Detailed chart review revealed one group of 200 PTS, 115 men (64 yr, 23-95) and 85 women (66 yr, 35-103) who had a single admission (SA). A second group of 249 multi-admission (MA) PTS: 133 men (68 yr, 21-93) and 116 women (69 yr, 33-100) admitted 794 times, averaging 3.2 admissions per patient. A significant difference between SA and MA existed with the presence of coronary artery disease (CAD) (39% vs 57%, p<.005), renal disease (RD) (24% vs 33%, p<.05) and pulmonary disease (PD) (25% vs 35% p< .01). Evaluation of admitting medications revealed significant difference between SA and MA in regards to utilization of: angiotensin converting enzyme inhibitor (36% vs 51%, p<.005), digoxin (22% vs 51%, p.<.005), and diuretics (50% vs 80%, p<.005). There was no significant difference in hypertension (72% vs 67%), diabetes (36% vs 39%), atrial fibrillation (27% vs 19%), left ventricular shortening fraction (24% vs 24%), echocardiographic evidence of mitral regurgitation (36% vs 28%), duration of symptoms (6.3 days vs 6.8 days), serum sodium (138 vs 138 meq/L), serum potassium (4.2 vs 4.3 meq/L), serum creatinine (2.4 vs 2.1 meq/L), admission systolic blood pressure (140 vs 134 mm Hg), or heart rate (93 vs 91 bpm). In conclusion, while MA were receiving significantly more cardiovascular medications than SA, the majority of traditional predictors of CHF failed to differentiate between these two groups. Only the presence of CAD, RD or PD indicated a propensity for PTS to be hospitalized greater than three times more than those PTS without these comorbidities.

Original languageEnglish (US)
JournalJournal of Investigative Medicine
Volume47
Issue number2
StatePublished - Feb 1999

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Pulmonary diseases
Patient Admission
Lung Diseases
Coronary Artery Disease
Heart Failure
Kidney
Digoxin
Blood pressure
Medical problems
Health care
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Serum
Creatinine
Potassium
Teaching
Blood Pressure
Sodium
Mitral Valve Insufficiency
Atrial Fibrillation

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Coronary artery, renal, and pulmonary disease predictive of multiple hospital admissions for patients with congestive heart failure. / Madriago, Erin J.; Baker, Larry; Kattan, Jessica; Childers, Melanie; Amsterdam, Ezra.

In: Journal of Investigative Medicine, Vol. 47, No. 2, 02.1999.

Research output: Contribution to journalArticle

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abstract = "Patients (PTS) with congestive heart failure (CHF) are a major concern for the health care commurity with increased hospitalizations and resource utilization. To better understand this important patient population, we evaluated PTS at a major teaching institution who admitted for the principle diagnosis of CHF over a 3.5 year period of time. The study group was comprised of 449 PTS: 248 men (63 yr, 21-95) and 201 women (68 yr, 33-103) who caused 994 admits. Detailed chart review revealed one group of 200 PTS, 115 men (64 yr, 23-95) and 85 women (66 yr, 35-103) who had a single admission (SA). A second group of 249 multi-admission (MA) PTS: 133 men (68 yr, 21-93) and 116 women (69 yr, 33-100) admitted 794 times, averaging 3.2 admissions per patient. A significant difference between SA and MA existed with the presence of coronary artery disease (CAD) (39{\%} vs 57{\%}, p<.005), renal disease (RD) (24{\%} vs 33{\%}, p<.05) and pulmonary disease (PD) (25{\%} vs 35{\%} p< .01). Evaluation of admitting medications revealed significant difference between SA and MA in regards to utilization of: angiotensin converting enzyme inhibitor (36{\%} vs 51{\%}, p<.005), digoxin (22{\%} vs 51{\%}, p.<.005), and diuretics (50{\%} vs 80{\%}, p<.005). There was no significant difference in hypertension (72{\%} vs 67{\%}), diabetes (36{\%} vs 39{\%}), atrial fibrillation (27{\%} vs 19{\%}), left ventricular shortening fraction (24{\%} vs 24{\%}), echocardiographic evidence of mitral regurgitation (36{\%} vs 28{\%}), duration of symptoms (6.3 days vs 6.8 days), serum sodium (138 vs 138 meq/L), serum potassium (4.2 vs 4.3 meq/L), serum creatinine (2.4 vs 2.1 meq/L), admission systolic blood pressure (140 vs 134 mm Hg), or heart rate (93 vs 91 bpm). In conclusion, while MA were receiving significantly more cardiovascular medications than SA, the majority of traditional predictors of CHF failed to differentiate between these two groups. Only the presence of CAD, RD or PD indicated a propensity for PTS to be hospitalized greater than three times more than those PTS without these comorbidities.",
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