| Summary: | 碩士 === 國立臺北護理健康大學 === 護理研究所 === 104 === Background：Heart failure is the leading clinical cause of re-hospitalization. HF is associated with high morbidity, mortality, health-care expenditures and has adverse effect on quality of life。
Objectives：The aim of study is to describe and explore the predictors of unscheduled re-hospitalization among patients with heart failure。
Methods: We will conduct a retrospective correlational study. A convenient sample of 118 patients with heart failure will be recruited from cardiovascular clinics of a medical center. After signing the consent form, participants will answer the study questionnaires. The questionnaires include questions on demographics and disease characteristics, Charlson comorbidity index, Mandarin Brief Health Literacy Screen, Dutch Heart Failure Knowledge Scale, Self-Care of Heart Failure Index, The Patient Health Questionnaire-9 (PHQ-9), and Multidimensional Scale of Perceived Social Support. We will collect the data on the frequency and causes of re-hospitalization of a patient in the previous year from his electronic medical record and his records on The National Health Insurance drug information Cloud. The SPSS 20.0 statistics software will be used to analyze data. The statistical analysis methods will include descriptive analysis, Chi-square test, one way ANOVA and Ordinal logistic regression. The results of this study will inform us the influencing factors of rehospitalizations in patients with heart failure。
Results: The average admission rate of patients with heart failure in the past one year was 0.095 times/per month (range :0 .00~0.50 times; S D = .089). The average rate of admission was 1.14 times (range: 0- 6 times; SD = 1.07). The causes of patients hospitalized with acute heart failure were mainly due to acute decompensation, ischemic heart disease (such as myocardial infarction and angina pectoris), arrhythmia and peripheral arterial disease. Average score of health literacy, heart failure disease knowledge, self-care to maintain, management, confidence dimension was 9.89 points (SD = 1.28), 6.38 points (SD = 3.24), 51.44 points (SD = 14.76), 47.08 points (SD = 14.76) and 51.12 points (SD = 22.66); respectively. Average score of depression scale and social support was 4.20 points (SD = 4.20) and 63.29 points (SD = 10.25). The monthly hospitalization rate difference in different gender within one year reached a statistically significance (t = -2.34, p <0.001) by Chi-square test. Pearson product-moment correlation coefficient analysis showed that monthly average admission rates was negatively associated with left ventricular ejection raction( r = -0. 232, p = 0.012) and health literacy (r = - 0.251, p = 0.006); and positively associated with heart failure morbidity rate ( per years) (r = 0.213,p = 0.02 ), left ventricular end-diastolic diameter (r =0 .236, p = 0.012), and Charlson comorbidity index (r =0 .281, p = 0.002). Linear regression analysis revealed Charlson comorbidity index, left ventricular end-diastolic diameter and gender were important predictors of hospitalization rates for heart failure within one year, which contributed 16.2% of the variance (F = 8.515, p<0.0001).
Conclusion: Our results showed that female, higher comorbidity index and longer left ventricular end-diastolic diameter had high risk of admission for heart failure. We should pay more attention to high risk patients about disease management, tracking and guiding self-care for preventing multiple hospitalizations caused by acute decompensated heart failure, ischemic causes (myocardial infarction and angina pectoris), arrhythmia and peripheral arterial disease.
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