Symptom exacerbation and hospitalization for heart failure: onset time, progression, and severity

Congestive heart failure (CHF) is generally described as a clinical syndrome characterized by impairments to the structure and function of the heart. CHF symptom exacerbation is responsible for more than 1 million hospital admissions annually and represents one of the largest Medicare expenditures. The purpose of this study was to determine the onset, progression, and severity of acute symptoms experienced prior to hospital admission. The specific aims of the study were to (i) describe onset times for acute symptoms, (ii) assess the severity of these symptoms prior to admission, and (iii) identify predictors of increased onset and severity of acute symptoms among persons with CHF. A total of 127 patients were interviewed following emergency admission to an urban university medical center. Interviews evaluated acute symptom scores, recent time-activity patterns, and chronic CHF experience. Acute symptoms (including shortness of breath, fatigue, and swelling) were assessed with a 10-point visual analog scale at four time periods prior to and at admission. In addition, follow-up information was collected by phone interview at 4 to 6 weeks after discharge. Average symptom scores demonstrated progressive worsening prior to admission. Two weeks before admission, the mean score for shortness of breath was 4.6 (SD = 3.0). At admission, this increased to 7.5 (SD = 2.9). Scores for other symptoms showed similar gains. Participants with self-described mild CHF reported greater increases in symptom scores at hospital admission compared with those with moderate or severe illness. Ranked scores did not differ for patients with prolonged discomfort compared with those describing rapid onset of symptom exacerbation. Patients hospitalized for exacerbation of CHF experience progressive worsening of acute symptoms prior to admission. The presence of additional chronic conditions, more severe CHF, and comorbid illnesses predict higher acute symptom scores. The understanding of the temporal onset of acute symptoms can aid in education and awareness for patients at risk of hospital admission due to aggravated heart failure conditions.