Predictors of early rehospitalization among African American and Caucasian women hospitalized with heart failure
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Background. Heart Failure remains a complex clinical syndrome that affects all races and backgrounds. Periodically individuals with a heart failure diagnosis will require hospitalization during the course of the disease progression. Consequently, early and repeated rehospitalizations for acute exacerbations presents additional social and economic difficulties. Prior research demonstrated that elderly African-American and Caucasian women account for a large proportion of the population at risk for future heart failure hospitalizations along with readmissions within 60 days of discharge. Unfortunately, the literature remains unpredictable or largely non-existent regarding the unique associations between risk predictors for heart failure
and early (31 to 60-day) heart failure rehospitalization in these two groups of women. Improved understanding of the predictors that influence avoidable early heart failure rehospitalization may engender strategies to reduce readmissions in these at-risk populations.
Purpose. Using a risk factor model for heart failure rehospitalization as a conceptual framework, this research determined if certain social, hemodynamic and comorbid risk factors associated with elderly African-American and Caucasian women HF patients influenced hospital readmission within 31 to 60-day of discharge.
Methods. The study utilized a descriptive, correlational, non-equivalent case-control, and quantitative study design that incorporated a retrospective review of the medical records of
elderly African-American and Caucasian women discharged or readmitted with a primary diagnosis of heart failure from October 2012 to October 2015. Predictor variables included
pulmonary hypertension, hypertension, diabetes mellitus, body mass index, social factors, heart failure with preserved or reduced ejection fraction, and race. The outcome variable measured was 31to 60-day heart failure rehospitalization following index heart failure hospitalization. Relationships among model variables were explored using multiple logistic regression analysis and cross-tabulation techniques.
Results. The full model containing all predictors was not supported, X2(21, N = 188) = 35.77, p = 0.120; indicating that the full model was not able to distinguish between predictors that contribute to rehospitalization after an index HF hospitalization. However, findings indicated that individual predictor variables including body mass index, age (75-80), and lipid-lowering agent made significant contributions to the prediction of HF rehospitalization within 31-60-day after an index HF hospitalization. Neither HFpEF nor HFrEF, or race, predicted the likelihood of HF rehospitalization after an index HF hospitalization, but the data showed that subjects with HFrEF were 1.6 times more likely to experience rehospitalization. Significant relationships were found between subtypes of heart failure (HFpEF or HFrEF) and obesity, diabetes mellitus, and
causes contributing to heart failure.
Implications. The findings of this study bear importance to nurse scientists and nurse practitioners who are directly involved in the care of patients with acute or chronic heart failure and want to influence heart failure rehospitalization. Implications for policy, future research, and limitations are presented.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 13861724; ProQuest document ID: 2240083674. The author still retains copyright.
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
Type | Dissertation |
Acquisition | Proxy-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Evidence Level | Descriptive/Correlational |
Research Approach | Quantitative Research |
Keywords | African-American Women; Caucasian Women; Hospital Readmissions; Heart Failure; Reduced Ejection Fraction |
Grantor | The Catholic University of America |
Advisor | Jairath, Nalini N.; Steffan, Nancy; Chandler, Arthur B. |
Level | PhD |
Year | 2019 |
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
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