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Vol 8, No 2 (2023)
Research paper
Published online: 2023-03-17
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Determination of factors related to emergency re-referral in patients with heart failure a hospital in Tehran — Iran: a cross-sectional study

Fateme Yazdi12, Ali Reza Ghahri Sarabi3, Fateme Monjazebi4, Arash Ziapour5, Francesco Chirico67, Malihe Nasiri8
DOI: 10.5603/DEMJ.a2023.0010
·
Disaster Emerg Med J 2023;8(2):71-82.
Affiliations
  1. School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. School of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran
  3. Department of Anesthesia and Operating Room, Faculty of Nursing and Midwifery Colleg, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. Department of Internal Medicine and Surgery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
  6. Post-Graduate School of Occupational Health, Universita Cattolica del Sacro Cuore, Rome, Italy
  7. Health Service Department, Italian State Police, Ministry of the Interior, Milan, Italy
  8. Department of Statistics, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

open access

Vol 8, No 2 (2023)
ORIGINAL ARTICLES
Published online: 2023-03-17

Abstract

INTRODUCTION: The re-referral of heart failure patients to the hospital is a significant health problem today and is one of the most costly and preventable events for these patients. The present study aimed to investigate the factors affecting the re-referral of patients with heart failure to the emergency department of Shahid Beheshti University of Medical Sciences in Tehran in 2021. Identifying these factors can lead to the recognition of patients at high risk for re-hospitalization and the design of preventive and effective interventions.

MATERIAL AND METHODS: This descriptive-correlational research was performed cross-sectionally. Ninety patients with heart failure who were re-referred to the emergency department of Masih Daneshvari Hospital entered the study. Sampling was done for 6 months from December 2020 to May 2021. Data collection tools included a researcher-made questionnaire and a European self-care questionnaire for heart failure patients, and the New York Heart Association Classification (NYHA) standard for classifying heart failure class. After completing the questionnaires, the collected data were analyzed by SPSS23 software.

RESULTS: The results showed that age (the mean age of the participants in the study was 69.9 years), duration of disease (77.8% was six months to four years), body mass index (the mean body mass index was 27.2) (demographic characteristics) dyspnea (78.9%), organs edema (47.8%), shortness of breath (pathological factors), high blood pressure (54.4%), diabetes (25%), chronic obstructive pulmonary disease (11.1%), and ischemic heart disease (3.3%), (background diseases), high creatinine (the mean 1.98), (laboratory findings), not using beta-blockers (18.4%) and not taking angiotensin receptor blockers (18.8%) (pharmacological agents), NYHA criteria (89% were in NYHA class 3 and 4) and self-care levels of heart failure patients (the mean self-care score was 37.4) have a statistically significant association to re-referrals to emergency (p- -value < 0.05).

CONCLUSIONS: Identify patients with a high risk of hospital re-referral and decrease additional costs imposed on care centers by recognizing the factors influencing the re-referral of patients with heart failure and design preventive and effective interventions. So, it is possible to increase the patient’s self-care level while reducing the number of re-referrals.

Abstract

INTRODUCTION: The re-referral of heart failure patients to the hospital is a significant health problem today and is one of the most costly and preventable events for these patients. The present study aimed to investigate the factors affecting the re-referral of patients with heart failure to the emergency department of Shahid Beheshti University of Medical Sciences in Tehran in 2021. Identifying these factors can lead to the recognition of patients at high risk for re-hospitalization and the design of preventive and effective interventions.

MATERIAL AND METHODS: This descriptive-correlational research was performed cross-sectionally. Ninety patients with heart failure who were re-referred to the emergency department of Masih Daneshvari Hospital entered the study. Sampling was done for 6 months from December 2020 to May 2021. Data collection tools included a researcher-made questionnaire and a European self-care questionnaire for heart failure patients, and the New York Heart Association Classification (NYHA) standard for classifying heart failure class. After completing the questionnaires, the collected data were analyzed by SPSS23 software.

RESULTS: The results showed that age (the mean age of the participants in the study was 69.9 years), duration of disease (77.8% was six months to four years), body mass index (the mean body mass index was 27.2) (demographic characteristics) dyspnea (78.9%), organs edema (47.8%), shortness of breath (pathological factors), high blood pressure (54.4%), diabetes (25%), chronic obstructive pulmonary disease (11.1%), and ischemic heart disease (3.3%), (background diseases), high creatinine (the mean 1.98), (laboratory findings), not using beta-blockers (18.4%) and not taking angiotensin receptor blockers (18.8%) (pharmacological agents), NYHA criteria (89% were in NYHA class 3 and 4) and self-care levels of heart failure patients (the mean self-care score was 37.4) have a statistically significant association to re-referrals to emergency (p- -value < 0.05).

CONCLUSIONS: Identify patients with a high risk of hospital re-referral and decrease additional costs imposed on care centers by recognizing the factors influencing the re-referral of patients with heart failure and design preventive and effective interventions. So, it is possible to increase the patient’s self-care level while reducing the number of re-referrals.

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Keywords

re-referral; heart failure; patients; hospital cooperation; Iran

About this article
Title

Determination of factors related to emergency re-referral in patients with heart failure a hospital in Tehran — Iran: a cross-sectional study

Journal

Disaster and Emergency Medicine Journal

Issue

Vol 8, No 2 (2023)

Article type

Research paper

Pages

71-82

Published online

2023-03-17

Page views

1273

Article views/downloads

253

DOI

10.5603/DEMJ.a2023.0010

Bibliographic record

Disaster Emerg Med J 2023;8(2):71-82.

Keywords

re-referral
heart failure
patients
hospital cooperation
Iran

Authors

Fateme Yazdi
Ali Reza Ghahri Sarabi
Fateme Monjazebi
Arash Ziapour
Francesco Chirico
Malihe Nasiri

References (58)
  1. Inamdar AA, Inamdar AC. Heart failure: diagnosis, management and utilization. J Clin Med. 2016; 5(7).
    CrossRefPubMed
  2. Redfield MM. Heart failure with preserved ejection fraction. N Engl J Med. 2016; 375(19): 1868–1877.
    CrossRefPubMed
  3. Nazari B, Bakhshi S, Kaboudi M, et al. Comparison of quality of life, anxiety and depression in children with cancer and healthy children, kermanshah-iran. Int J Pediatr. 2017; 5(7): 5305–5314.
    CrossRef
  4. Rezaei F, Maracy M, Yarmohammadian M, et al. Hospitals preparedness using WHO guideline: a systematic review and meta-analysis. Hong Kong Journal of Emergency Medicine. 2018; 25(4): 211–222.
    CrossRef
  5. Conrad N, Judge A, Tran J, et al. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet. 2018; 391(10120): 572–580.
    CrossRefPubMed
  6. Ahmadi A, Soori H, Mobasheri M, et al. Heart failure, the outcomes, predictive and related factors in Iran. J Mazandaran Univ Med Sci. 2014; 24(118): 180–8.
  7. Bahrami M, Etemadifar S, Shahriari M, et al. Caregiver burden among Iranian heart failure family caregivers: a descriptive, exploratory, qualitative study. Iran J Nurs Midwifery Res. 2014; 19(1): 56–63.
    PubMed
  8. Baniasadi H, Hosseini SS, Abdollahyar A, et al. Effect of massage on behavioural responses of preterm infants in an educational hospital in Iran. J Reprod Infant Psychol. 2019; 37(3): 302–310.
    CrossRefPubMed
  9. Nobakht S, Shirdel A, Molavi-Taleghani Y, et al. Human resources for health: a narrative review of adequacy and distribution of clinical and nonclinical human resources in hospitals of Iran. Int J Health Plann Manage. 2018 [Epub ahead of print].
    CrossRefPubMed
  10. Dehghan F, Kaboudi M, Ziapour A. The effect of acceptance and commitment therapy on the mental health of women patients with type II diabetes. Annals of Tropical Medicine and Public Health. 2017; 10(6): 1709–1713.
    CrossRef
  11. Sheikhbardsiri H, Raeisi A, Khademipour G. Domestic violence against women working in four educational hospitals in Iran. J Interpers Violence. 2020; 35(21-22): 5107–5121.
    CrossRefPubMed
  12. Farré N, Vela E, Clèries M, et al. Real world heart failure epidemiology and outcome: a population-based analysis of 88,195 patients. PLoS One. 2017; 12(2): e0172745.
    CrossRefPubMed
  13. Nouhi E, Jahani Y. The study of palliative care and its relationship with quality of life in patients with chronic heart failure. in 2014-2015. J Clin Nurs Mid. 2017; 5(4): 35–46.
  14. Ziapour A, Zokaei A, Kahrizy FA. Theoretical study of the standing of social investment in the health sector. Soc Sci. 2016; 11(15): 3682–7.
  15. Sheikhbardsiri H, Doustmohammadi MM, Mousavi SH, et al. Qualitative study of health system preparedness for successful implementation of disaster exercises in the iranian context. Disaster Med Public Health Prep. 2022; 16(2): 500–509.
    CrossRefPubMed
  16. Moussa NB, Karsenty C, Pontnau F, et al. Characteristics and outcomes of heart failure-related hospitalization in adults with congenital heart disease. Arch Cardiovasc Dis. 2017; 110(5): 283–291.
    CrossRefPubMed
  17. Ferdosi M, Vatankhah S, Khalesi N, et al. Designing a referral system management model for direct treatment in social security organization. J Military Med. 2012; 14(2): 129–35.
  18. Sheikhbardsiri H, Afshar PJ, Baniasadi H, et al. Workplace violence against prehospital paramedic personnel (city and road) and factors related to this type of violence in iran. J Interpers Violence. 2022; 37(13-14): NP11683–NP11698.
    CrossRefPubMed
  19. Abir M, Goldstick JE, Malsberger R, et al. Evaluating the impact of emergency department crowding on disposition patterns and outcomes of discharged patients. Int J Emerg Med. 2019; 12(1): 4.
    CrossRefPubMed
  20. Mohammadi M, Esfandnia A, Rezaei S, et al. Performance evaluation of hospitals under supervision of kermanshah medical sciences using pabonlasoty diagram of a five-year period (2008-2012). Life Sci J. 2014; 11(Special Issue 1): 77–81.
  21. Chiu IM, Lin YR, Syue YJ, et al. The influence of crowding on clinical practice in the emergency department. Am J Emerg Med. 2018; 36(1): 56–60.
    CrossRefPubMed
  22. Chang AM, Cohen DJ, Lin A, et al. Hospital strategies for reducing emergency department crowding: a mixed-methods study. Ann Emerg Med. 2018; 71(4): 497–505.e4.
    CrossRefPubMed
  23. Kim J, Yun BJ, Aaronson EL, et al. The next step to reducing emergency department (ED) crowding: engaging specialist physicians. PLoS One. 2018; 13(8): e0201393.
    CrossRefPubMed
  24. Zuckerman RB, Sheingold SH, Orav EJ, et al. Readmissions, observation, and the hospital readmissions reduction program. N Engl J Med. 2016; 374(16): 1543–1551.
    CrossRefPubMed
  25. Sheikhbardsiri H, Khademipour G, Davarani ER, et al. Response capability of hospitals to an incident caused by mass gatherings in southeast Iran. Injury. 2022; 53(5): 1722–1726.
    CrossRefPubMed
  26. Aminizadeh M, Saberinia A, Salahi S, et al. Quality of working life and organizational commitment of Iranian pre-hospital paramedic employees during the 2019 novel coronavirus outbreak. International Journal of Healthcare Management. 2021; 15(1): 36–44.
    CrossRef
  27. Mahajan SM, Heidenreich P, Abbott B, et al. Predictive models for identifying risk of readmission after index hospitalization for heart failure: a systematic review. Eur J Cardiovasc Nurs. 2018; 17(8): 675–689.
    CrossRefPubMed
  28. Mudge A, Denaro C, Scott I, et al. The paradox of readmission: effect of a quality improvement program in hospitalized patients with heart failure. J Hosp Med. 2010; 5(3): 148–153.
    CrossRefPubMed
  29. Rice H, Say R, Betihavas V. The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review. Patient Educ Couns. 2018; 101(3): 363–374.
    CrossRefPubMed
  30. Stauffer BD, Fullerton C, Fleming N, et al. Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent controls. Arch Intern Med. 2011; 171(14): 1238–1243.
    CrossRefPubMed
  31. Heidarijamebozorgi M, Jafari H, Sadeghi R, et al. The prevalence of depression, anxiety, and stress among nurses during the coronavirus disease 2019: a comparison between nurses in the frontline and the second line of care delivery. Nurs Mid Stud. 2021; 10(3): 188–193.
  32. Lebni JY, Toghroli R, Abbas J, et al. Nurses' work-related quality of life and its influencing demographic factors at a public hospital in western iran: a cross-sectional study. Int Q Community Health Educ. 2021; 42(1): 37–45.
    CrossRefPubMed
  33. Bagheri–Saweh M, Lotfi A, Ghasemi SS. Self-care behaviors and related factors in chronic heart failure patients. International Journal of Biomedicine and Public Health. 2018; 1(1): 42–47.
    CrossRef
  34. Sidebottom AC, Jorgenson A, Richards H, et al. Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial. J Palliat Med. 2015; 18(2): 134–142.
    CrossRefPubMed
  35. Heydari A, Ziaee ES, Ebrahimzade S. The frequency of rehospitalization and its contributing factors in patient with cardiovascular diseases hospitalized in selected hospitals in Mashhad in 2010. Horizon Med Sci. 2011; 17(2): 65–71.
  36. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Committee for Practice Guidelines (CPG). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail. 2008; 10(10): 933–989.
    CrossRefPubMed
  37. Jaarsma T, Strömberg A, Mårtensson J, et al. Development and testing of the european heart failure self-care behaviour scale. Eur J Heart Fail. 2003; 5(3): 363–370.
    CrossRefPubMed
  38. Khoshtarash M, Momeni M, Ghanbari A, et al. Self-care behaviors and related factors in patients with heart failure reffering to‎ medical & educational center of heart in Rasht‎. J Holistic Nurs Mid. 2013; 23(1): 22–9.
  39. Bhatia V, Bajaj NS, Sanam K, et al. Beta-blocker use and 30-day all-cause readmission in medicare beneficiaries with systolic heart failure. Am J Med. 2015; 128(7): 715–721.
    CrossRefPubMed
  40. Dharmarajan K, Hsieh A, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013; 309(4): 355.
    CrossRef
  41. Hamner JB, Ellison KJo. Predictors of hospital readmission after discharge in patients with congestive heart failure. Heart Lung. 2005; 34(4): 231–239.
    CrossRefPubMed
  42. Lim NK, Lee SE, Lee HY, et al. Risk prediction for 30-day heart failure-specific readmission or death after discharge: Data from the Korean Acute Heart Failure (KorAHF) registry. J Cardiol. 2019; 73(2): 108–113.
    CrossRefPubMed
  43. Bathaei S, Ashktorab T, Zohari AS, et al. Personal factors contributing to readmission of patients with congestive heart failure. J Crit Care Nurs. 2009; 2(3): 109–12.
  44. Ashktorab T, Bathaei S, Zohari An, et al. Factors Associated with Readmission of Patients with Congestive Heart Failure in the Internal Ward of Hospitals affiliated to Shahid Beheshti University of Medical Sciences. J Shahid Beheshti Univ Med Sci. 2003; 21: 19–24.
  45. Roohani M, Gheiasi F, Hanifi N, et al. Effect of learning needs based teaching on frequency and readmission of heart failure patients and their families. Prev Care Nurs Mid J. 2016; 6(3): 1–11.
  46. Hekmatpou D, Mohammadi E, Ahmadi F. Barriers of readmission control among patients with congestive heart failure: A qualitative study. J Arak Univ Med Sci. 2008; 11(4): 49–58.
  47. Shah R, Gayat E, Januzzi JL, et al. GREAT (Global Research on Acute Conditions Team) Network. Body mass index and mortality in acutely decompensated heart failure across the world: a global obesity paradox. J Am Coll Cardiol. 2014; 63(8): 778–785.
    CrossRefPubMed
  48. Arora S, Patel P, Lahewala S, et al. Etiologies, trends, and predictors of 30-day readmission in patients with heart failure. Am J Cardiol. 2017; 119(5): 760–769.
    CrossRefPubMed
  49. Farasat SM, Bolger DT, Shetty V, et al. Effect of beta-blocker therapy on rehospitalization rates in women versus men with heart failure and preserved ejection fraction. Am J Cardiol. 2010; 105(2): 229–234.
    CrossRefPubMed
  50. Retrum JH, Boggs J, Hersh A, et al. Patient-identified factors related to heart failure readmissions. Circ Cardiovasc Qual Outcomes. 2013; 6(2): 171–177.
    CrossRefPubMed
  51. Gheorghiade M, Gattis WA, O'Connor CM. Treatment gaps in the pharmacologic management of heart failure. Rev Cardiovasc Med. 2002; 3 Suppl 3: S11–S19.
    PubMed
  52. Muzzarelli S, Leibundgut G, Maeder MT, et al. TIME-CHF Investigators. Predictors of early readmission or death in elderly patients with heart failure. Am Heart J. 2010; 160(2): 308–314.
    CrossRefPubMed
  53. Moser DK, Frazier SK, Worrall-Carter L, et al. Symptom variability, not severity, predicts rehospitalization and mortality in patients with heart failure. Eur J Cardiovasc Nurs. 2011; 10(2): 124–129.
    CrossRefPubMed
  54. Aranda JM, Johnson JW, Conti JB. Current trends in heart failure readmission rates: analysis of Medicare data. Clin Cardiol. 2009; 32(1): 47–52.
    CrossRefPubMed
  55. Pierre-Louis B, Rodriques S, Gorospe V, et al. Clinical factors associated with early readmission among acutely decompensated heart failure patients. Arch Med Sci. 2016; 12(3): 538–545.
    CrossRefPubMed
  56. Sanam K, Bhatia V, Bajaj NS, et al. Renin-angiotensin system inhibition and lower 30-day all-cause readmission in medicare beneficiaries with heart failure. Am J Med. 2016; 129(10): 1067–1073.
    CrossRefPubMed
  57. Setoguchi M, Hashimoto Y, Sasaoka T, et al. Risk factors for rehospitalization in heart failure with preserved ejection fraction compared with reduced ejection fraction. Heart Vessels. 2015; 30(5): 595–603.
    CrossRefPubMed
  58. Ditewig JB, Blok H, Havers J, et al. Effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: a systematic review. Patient Educ Couns. 2010; 78(3): 297–315.
    CrossRefPubMed

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