Heart Failure Rehospitalization and Delayed Decision Making: The Impact of Self-care and Depression

• Published in: The Journal of cardiovascular nursing Vol. 33; no. 1; pp. 30 - 39
• Main Authors: Xu, Jiayun, Gallo, Joseph J, Wenzel, Jennifer, Nolan, Marie T, Budhathoki, Chakra, Abshire, Martha, Bower, Kelsey, Arruda, Sofia, Flowers, Deirdre, Szanton, Sarah L, Dennison Himmelfarb, Cheryl, Gonzalez, Kaylin, Han, Hae-Ra
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-01-2018; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Activities of daily living; Adult; Aged; Aged, 80 and over; Clinical decision making; Confidence intervals; Cross-Sectional Studies; Decision Making; Depression - psychology; Female; Heart failure; Heart Failure - psychology; Heart Failure - therapy; Hospitalization; Humans; Male; Mental depression; Middle Aged; Nursing; Patient Acceptance of Health Care; Patient Readmission; Patient-centered care; Self Care; Socioeconomic Factors; Time Factors
• ISSN: 0889-4655; 1550-5049
• DOI: 10.1097/JCN.0000000000000423

BACKGROUND:Rehospitalization soon after discharge can be distressing for persons with heart failure (HF) and places a heavy burden on the healthcare system.
OBJECTIVE:We investigated and explored the association of self-care decision making variables with (1) rehospitalization within 30 days of discharge and (2) delay in seeking medical assistance (delayed decision making).
METHODS:A cross-sectional, explanatory sequential mixed methods design (quan > qual) was used to survey 127 hospitalized HF patients and interview 15 of these participants to explain their survey responses. The survey assessed rehospitalization within 30 days of discharge, delayed decision making, HF self-care, and psychosocial factors influencing self-care.
RESULTS:The likelihood of delaying the decision to be hospitalized was more than 5 times higher among those with high depressive symptoms (odds ratio, 5.33; 95% confidence interval, 2.14–13.28). Those who delayed going to the hospital were uncertain about their prognosis and did not feel their symptoms were urgent. The likelihood of being rehospitalized within 30 days was more than doubled among those with high depressive symptoms (OR, 2.31; 95% confidence interval, 1.01–5.31). Those who were rehospitalized within 30 days were less likely to consult healthcare professionals in their decision making and wanted immediate relief from their symptoms.
CONCLUSIONS:We recommend a patient-centered approach to help HF patients identify and adequately self-manage symptoms. The strong association between high depressive symptoms and rehospitalization within 30 days as well as delayed decision making highlights the critical need for clinicians to carefully assess and address depression among HF patients.