CHF is the most common cause of hospital admission in the Medicare population. CMS has instituted policies penalizing Hospitals that have a high readmission rate. This has lead institution to focus on methods to reduce readmission; most of these efforts emphasize improving easy access to improve/stabilize the patient’s cardiac condition. A few studies have suggested that a readmission for CHF may represent a more complex questions relating to overall function of the patient, such as whether the patient has impairment in their ADL/IADL, presence of dementia, anxiety, depression or had inadequate health literacy. We wished to extend those studies and also questioned whether caregiver burden could be a factor in the rate of readmission. Caregiver burden is common and represents the amount of stress that care giver has in taking care of the patient and perhaps whether the patient care giver may have been overwhelmed by the patient’s condition.
Data was collected in a prospective fashion from patients admitted. Seventy‐six consecutive patients who were 18 years or older and admitted with the primary diagnosis of heart failure were interviewed from September 2012 through August 2013. Charts were systematically reviewed thirty days post discharge using a data collection sheet that incorporated the use of the Framingham Criteria for diagnosis of CHF. We screened for generalized anxiety disorder using the GAD‐7 and depression, using the PHQ‐9 questionnaire. Health literacy was assessed using a three‐questions survey. Finally, in patients dependent for ADL’s the patient’s primary caregiver was assessed for caregiver’s burden using the modified Zarit Burden interview.
76 patients met criteria, but 10 did not consent to participate, 66 were included in the study. 40.9% of patients were white Hispanic females. 71.2% patients were 65 years or older. 69.7% had depression with 24.2% having severe depression. 51.5% of patients had anxiety. 51.5% of patients had low health literacy. 95.4% had 3 or more comorbidities. 27.3% were readmitted within 30 days, of which, 78.9% had depression, 63.2% had anxiety, 52.6% had a low health literacy level and 26.3% had caregiver’s burden.
A significant relationship was observed between anxiety, depression and readmissions due to CHF exacerbations. The data supported our hypothesis that low health literacy is associated with hospital readmission. However, our study did not establish a relationship between caregiver’s burden and readmission within 30 days.
To cite this abstract:Bossous P, Bullen‐ A, Clarke , Hanley J. Implications of Anxiety, Depression, Poor Health Literacy and Caregivers Burden, on Thirty Day Hospital Readmission Rates in Patients with Congestive Heart Failure (Chf). Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 102. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/implications-of-anxiety-depression-poor-health-literacy-and-caregivers-burden-on-thirty-day-hospital-readmission-rates-in-patients-with-congestive-heart-failure-chf/. Accessed April 7, 2020.