Search

This study examines the relationship between social network and hospital readmission and mortality in older patients with heart failure.Prospective study conducted with 371 patients, age 65 and older, admitted for heart failure-related emergencies at 4 Spanish hospitals. Social network was measured at baseline with a 4-item questionnaire that ascertained whether subjects were married, lived with another person(s), saw or had telephone contact with family members daily or almost daily, and were at home alone for less than 2 hours per day. Social network was deemed "high" where all 4 items were present, "moderate" where 3 were present, and "low" where 2 or fewer were present. Analyses were performed using Cox models, and adjusted for the main confounders. A total of 55% of patients had high or moderate social networks. During a median follow-up of 6.5 months, 135 (36.4%) patients underwent a first emergency rehospitalization and 68 (18.3%) died. Compared with patients with high social network, hospital readmission was more frequent among those who had moderate (hazard ratio [HR] 1.87; 95% confidence interval [CI] 1.06-3.29; P.05) and low social networks (HR 1.98; 95% CI 1.07-3.68; P.05). This relationship showed a positive dose-response (p for linear trend 0.042). The magnitude of this association was comparable to that of other important predictors of readmission, such as previous hospitalization. No relationship was observed between social network and death.A very simple questionnaire measuring social network can identify patients with a higher short-term risk of hospital readmission.

Introduccion y objetivos En este trabajo se estima la prevalencia de depresion y se identifican los factores biomedicos y psicosociales asociados en ancianos hospitalizados con insuficiencia cardiaca en Espana. Metodos Se estudio a 433 pacientes ≥ 65 anos ingresados de urgencia en 4 hospitales espanoles desde enero de 2000 hasta junio de 2001, con diagnostico principal o secundario de insuficiencia cardiaca. Se considero que habia depresion ante la presencia de 3 sintomas en la Escala de Depresion Geriatrica de 10 items. Resultados Del total de pacientes estudiados, 210 (48,5%) presentaron depresion. Las cifras correspondientes fueron 71 (37,6%) en varones y 139 (57,0%) en mujeres. La depresion fue mas frecuente en los pacientes con las siguientes caracteristicas: grado funcional III-IV de la NYHA (odds ratio ajustada [ORa] = 2,00; intervalo de confianza [IC] del 95%, 1,23-3,24); peor puntuacion en los aspectos fisicos de la calidad vida (ORa = 3,14; IC del 95%,1,98-4,99); dependencia en 1 o 2 actividades basicas de la vida diaria (ABVD) (ORa = 2,52; IC del 95%, 1,41-4,51); dependencia en 3 o mas ABVD (ORa = 2,47; IC del 95%, 1,20-5,07); limitacion en alguna actividad instrumental de la vida diaria (ORa = 2,20; IC del 95%, 1,28-3,79); hospitalizacion previa por insuficiencia cardiaca (ORa = 1,71; IC del 95%, 1,93-5,45); estaban solos en casa mas de 2 h al dia (ORa = 3,24; IC del 95%, 1,93-5,45); menor satisfaccion con el medico de atencion primaria (ORa = 1,90; IC del 95%, 1,14-3,17). Conclusiones La depresion es muy frecuente en los ancianos hospitalizados con insuficiencia cardiaca, y se asocia con varios factores biomedicos y psicosociales. Esta elevada frecuencia, el peor pronostico de la insuficiencia cardiaca en presencia de sintomas depresivos y la existencia de instrumentos diagnosticos sencillos y un tratamiento eficaz apoyan el cribado sistematico de la depression en estos pacientes.

Introduction and objectives This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain. Methods The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale. Results In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23–3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98–4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41–4.51), being dependent for >3 BADLs (aOR=2.47; 95% CI, 1.20–5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28–3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93–5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93–5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14–3.17). Conclusions Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients.

This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain.The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale.In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent foror =3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17).Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients.

Background: We sought to examine the relationship between health-related quality of life (HRQL) and a first emergencyrehospitalizationandmortalityinpatientswith heart failure (HF) having a wide variation in ventricular ejection fraction and functional status. Methods: Prospective study conducted with 394 patients admitted for HF-related emergencies at 4 Spanish hospitals. Baseline HRQL was measured with a generic questionnaire, the Medical Outcomes Study 36-item Short Form Survey (SF-36), and with an HF-specific instrument, the Minnesota Living With Heart Failure (MLWHF)questionnaire.Coxproportionalhazardsmodels were used to calculate hazard ratios (HRs) for hospitalization and death on the basis of HRQL scores. Results: During a median follow-up of approximately 6 months, 138 patients (35.0%) underwent a first emergency rehospitalization and 70 (17.8%) died. After adjustment for biomedical, psychosocial, and health care variables, the frequency of hospital readmission was higher in patients with worse scores on the SF-36 physical functioning (HR, 1.65; 95% confidence interval [CI], 1.11-2.44; P=.01), general health (HR, 1.73; 95% CI, 1.19-2.52; P=.003), and mental health (HR, 1.65; 95% CI, 1.10-2.47;P=.02) subscales. Results were similar for the mortality end point. For the MLWHF questionnaire, worse overall and worse physical and emotional summary scores were associated with higher mortality. Conclusions: Worse HRQL is associated with hospital readmission and death in patients with HF. The magnitude of this association, for both physical and mental HRQL components, is comparable to that for other wellknownpredictorsofhospitalreadmissionanddeath,such as personal history of diabetes, previous hospitalizations, and treatment with angiotensin-converting enzyme inhibitors. Arch Intern Med. 2005;165:1274-1279