Graduation Semester and Year

2014

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Nursing

Department

Nursing

First Advisor

Donelle M Barnes

Abstract

Purpose: There has been no significant improvement in heart failure (HF) readmissions regionally or nationally in the United States over the past decade. Additionally, there is no consensus nationally on defining the complex disease state of HF. This study retrospectively describes the accuracy of HF diagnoses in an adult HF patient population in a large metropolitan hospital setting. It also compares readmission rates between patients who were accurately diagnosed for HF versus those who were inaccurately diagnosed.Methods: A retrospective record review (N = 712) was performed at a large metropolitan health care center in North Texas from January 2012 to December 2012. Patients with a reported primary diagnosis for HF were reviewed. Key patient variables were collected and analyzed to determine diagnosis accuracy. Thirty-day readmission rates were compared between accurately versus inaccurately diagnosed patients. Additionally, predictors for readmissions for either HF or non-HF-related causes were described. Results: A total of 133 patients (18.7%) had a low probability of an accurate diagnosis. Additionally, having an inaccurate diagnosis was found to be predictive of being readmitted more frequently for non-HF causes (P = 0.018), as well as documented arrhythmias (P = 0.0230). Patient age > 60 years was predictive for non-HF (P = 0.0059) and HF (P = 0.0179) readmissions. Documented sleep apnea (P = 0.0350), percutaneous coronary intervention (P = 0.0059), non-white race (P = 0.0466), and B-type natriuretic peptide > 400 (P = 0.0066) were predictive for HF readmissions. Conclusions: In this cohort, 18.7% of patients admitted with a primary diagnosis of HF were determined to be inaccurately diagnosed. Moreover, an inaccurate diagnosis for HF resulted in patients being 2 times more likely to be readmitted for non-HF-related causes. An inaccurate diagnosis should be considered a determinant for all-cause readmissions in this patient population.

Disciplines

Medicine and Health Sciences | Nursing

Comments

Degree granted by The University of Texas at Arlington

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