Factors contributing to the hospitalization of patients with congestive heart failure

Objectives. This study identifies acute precipitants of hospitalization and evaluates utilization of angiotensin-converting enzyme inhibitors in patients admitted with congestive heart failure. Methods. Cross-sectional chart-review study was done of 435 patients admitted nonelectively from February 1993 to February 1994 to an urban university hospital with a complaint of shortness of breath or fatigue and evidence of congestive heart failure. Results. The most common identifiable abnormalities associated with clinical deterioration prior to admission were acute anginal chest pain (33%), respiratory infection (16%), uncontrolled hypertension with initial systolic blood pressure ≤180 mm Hg (15%), atrial arrhythmia with heart rate ≤120 (8%), and noncompliance with medications (15%) or diet (6%); in 34% of patients, no clear cause could be identified. After exclusion of those who were already on a different vasodilator or who had relative contraindications, 18 (32%) of the patients with ejection fractions ≤0.35 measured prior to admission were not taking an angiotensin-converting enzyme inhibitor on presentation to the hospital. Conclusions. Interventions to improve compliance, the control of hypertension, and the appropriate use of angiotensin-converting enzyme inhibitors may prevent many hospitalizations of heart-failure patients.