Tobacco, Alcohol Use Increase Risk of Hospitalization
Hospital readmission for heart failure is increasing. Discovering reversible risk factors for these hospitalizations may assist in reducing patient morbidity and hospital costs for management of heart failure.
Evangelista and colleagues studied the relationship between continued smoking and alcohol consumption after an index hospital admission for heart failure and the rate of readmission during the year after discharge. The researchers examined the following variables: current smoking, current alcohol use, sociodemographics, health history and support systems. Using a retrospective chart audit, researchers identified 753 consecutive patients who were admitted and discharged with heart failure from a veterans' hospital health care system over a two-year period. Patients with a single hospital admission were identified as group 1 (533 patients), and patients with multiple hospital admissions within one year of their index admission were identified as group 2 (220 patients). Chart data on smoking and alcohol use were recorded as either current, former or never. The mean age of the patients was 69 years; 98 percent of the patients were men.
Patient Characteristics in Single and Multiple Admission Groups
Group 1 (533 patients)* Group 2 (220 patients)§ P value Age (years; mean ± SD) 69.17 ± 11.70 69.0 ± 11.59 0.449 Gender 0.304 Male 98.5% 99.5% Female 1.5% 0.5% Race 0.291 White 62.7% 55.9% Black 24.4% 38.2% Other 12.9% 5.9% Marital status 0.872 Married 37.9% 37.3% Not married 62.1% 62.7% Living arrangement 0.001 Alone 44.1% 58.6% With someone 55.9% 41.4% Type of physician 0.000 Cardiologist 53.3% 28.6% Generalist 46.7% 71.4% Heart failure etiology 0.000 Nonischemic 69.0% 55.5% Ischemic 31.0% 44.6% NYHA class 0.000 1 40.3% 2.7% 2 43.3% 84.5% 3 16.3% 11.4% 4 0.1% 1.4% Heart failure (years); mean ± SD) 5.09 ± 3.71 6.37 ± 5.58 0.001
SD = standard deviation; NYHA = New York Heart Association.
*--Single-admission group.
§--Multiple-admission group.Adapted with permission from Evangelista LS, Doering LV, Dracup K. Usefulness of a history of tobacco and alcohol use in predicting multiple heart failure readmissions among veterans. Am J Cardiol 2000;86:1341.
There were significant differences in smoking and alcohol use between the two groups. In group 1, approximately 20 percent of patients continued to smoke and 30 percent continued to drink. In group 2, the rate rose significantly to approximately 70 percent for both smoking and alcohol use. Patients who continued to smoke and use alcohol were two and five times as likely to have multiple readmissions, respectively. There also was a high correlation between noncompliance to smoking restrictions and noncompliance to alcohol restrictions among all patients in the sample. Other predictors of multiple readmission are listed in the accompanying table.
The authors conclude that continued alcohol use and smoking are predictors of multiple heart-failure readmission in a population of primarily male veterans. Patients at risk for hospital readmission for heart failure should be identified, educated and referred for medical evaluation and treatment to heart failure specialists to prevent heart failure decompensation.
RICHARD SADOVSKY, M.D.
Evangelista LS, et al. Usefulness of a history of tobacco and alcohol use in predicting multiple heart failure readmissions among veterans. Am J Cardiol December 15, 2000;86:1339-42.
Copyright © 2001 by the American Academy of Family Physicians.
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