Do psychosocial factors affect readmission in heart failure patients? A single centre study in a veteran population in south Florida, USA

Background We aim to determine the influence of psychosocial factors on readmission rates in a south Florida hospital serving a largely minority Veteran population with unique psychosocial co-morbidities that impact their health care. Purpose We aim determine which psychosocial factors are predictors of readmission in patients with heart failure (HF). Methods This is a retrospective study conducted at the Miami Veteran Affairs Medical Center (VAMC) in South Florida, USA. Patients who were admitted for heart failure exacerbations from September 2018 to August 2019 were identified and included in this study. Data on baseline charateristics and co-morbidities was obtained from review of patients' electronic health records. Psychosocial assessment was done via telephone interview using a previously validated questionnaire on gender, self-reported ethnicity, level of education, marital status, employment status, homelessness, monthly financial strain, overall stress level, neighbourhood safety and social interaction. Perceived health competence was assessed with the two items Perceived Health Competence Scale (PHCS-2). Results We identified 185 patients during the study period (mean age 70.8±11.9 years, 98% male). Thirty-eight of these patients had one or more readmissions within one year. Our cohort was 22% White, 15% Hispanic and 60% African American based on self-reported race. We interviewed 78 patients; 14 with readmission, 64 without readmission. 21% had died at the time of our follow-up and we were unable to contact 27% of patients. On univariate analysis, homelessness and ejection fraction (LVEF) ≤40% were significantly associated with HF readmission (OR 8.3 p=0.002 and OR 6.8 p=0.008, respectively). No significant differences in other psychosocial characteristics were noted between groups. After adjustment for age in multivariate analysis, homelessness and LVEF <40% remained significant predictors for HF readmission (OR 13.4 p=0.005 and OR 8.8 p=0.02, respectively). Conclusions Our study population was largely a minority population (15% Hispanic and 60% African American). After comparing multiple psychosocial factors, homelessness was found to be a significant and independent risk factor for heart failure readmission. This suggests that the recent focus on heart failure readmissions may need to include social interventions targeting homelessness. Future research should aim to determine whether multidisciplinary interventions aimed at addressing homelessness in patients with heart failure would help reduce hospital readmissions for congestive heart failure. Funding Acknowledgement Type of funding source: None

Impact of Perceived Health Competence on the Quality of Life of Emerging Adults With Chronic Health Conditions

Emerging adults with chronic health conditions (CHCs) face additional challenges compared to their peers during this transitional period, which can exacerbate their symptoms and negatively impact their quality of life (QoL). This study assessed the impact of CHC status and the potential protective factor of perceived health competence (PHC) on QoL. Nine hundred twenty-nine emerging adults, aged 18–25 years ( M age = 22.19, SD = 1.95; 55% female), participated in the current study as part of a larger online survey. Results showed that those with a CHC reported significantly lower QoL than those without a CHC. Additionally, higher PHC was associated with higher QoL for both groups of emerging adults. Although the current study identified some factors that may differentially impact this positive association, the results consistently suggest that promotion of emerging adults’ PHC may play a key role in improving their QoL during this transitional period, regardless of CHC status.

Perceived health competence predicts anxiety and depressive symptoms after a three-year follow-up among adolescents and adults with congenital heart disease

Background: Congenital heart disease places survivors at increased risk for cardiovascular complications as they age and requires long-term medical management. Perceived health competence, or how capable one feels in managing one’s health, is linked to emotional adjustment in various disease populations, but has not been investigated among congenital heart disease survivors. Aim: The purpose of this study was to examine the relationship of perceived health competence at baseline (T1) as a predictor of anxiety and depressive symptoms three years later (T2). Methods: Congenital heart disease survivors ( n=125; MT1age=27; 58.6% female; severity of cardiac lesion: 25% simple, 44% moderate, 31% complex) were recruited from a pediatric and an adult hospital as part of a larger study. Participants completed the Perceived Health Competence Scale and the Youth or Adult Self-Report at T1 for anxiety and affective/depressive symptoms. At T2, participants completed the Hospital Anxiety and Depression Scale. New York Heart Association functional class, a measure of functional impairment, was abstracted from medical charts at T2. Results: Lower T1 perceived health competence was significantly associated with greater emotional distress at T1 (depression r=−0.47; anxiety: r=−0.45), as well as greater T2 functional impairment ( r=−0.41). T1 perceived health competence also predicted T2 anxiety and depressive symptoms, which remained significant when including T1 anxiety and depressive symptoms and T2 functional impairment. Conclusion: Congenital heart disease survivors who feel more competent in managing their health may be less likely to experience future anxiety and depressive symptoms. Perceived health competence may be a worthwhile target for psychosocial intervention to promote emotional wellbeing among congenital heart disease survivors and ensure the best outcomes.