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Am Fam Physician. 2001;63(12):2449-2450

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.

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.

Group 1 (533 patients)*Group 2 (220 patients)Pvalue
Age (years; mean ± SD)69.17 ± 11.7069.0 ± 11.590.449
Gender0.304
Male98.5%99.5%
Female1.5%0.5%
Race0.291
White62.7%55.9%
Black24.4%38.2%
Other12.9%5.9%
Marital status0.872
Married37.9%37.3%
Not married62.1%62.7%
Living arrangement0.001
Alone44.1%58.6%
With someone55.9%41.4%
Type of physician0.000.
Cardiologist53.3%28.6%
Generalist46.7%71.4%
Heart failure etiology0.000
Nonischemic69.0%55.5%
Ischemic31.0%44.6%
NYHA class0.000
140.3%2.7%
243.3%84.5%
316.3%11.4%
40.1%1.4%
Heart failure (years); mean ± SD)5.09 ± 3.716.37 ± 5.580.001

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.

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