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COJ Nursing & Healthcare

An Exploration of Factors Related to Rehospitalisation for Patients with Chronic Heart Failure

Chunhua Ma*

Associate Professor, School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, China

*Corresponding author: Chunhua Ma, Associate Professor, School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, China, Email:

Submission: August 17, 2020;Published: September 02, 2020

DOI: 10.31031/COJNH.2020.06.000642

ISSN: 2577-2007
Volume6 Issue4


Background: The previous studies showed many factors impacting rehospitalisation, such as, demographic factors, clinical factors, and psychological factors, however, none studies focus on associations between patient activation, self-efficacy, heart failure knowledge, medication adherence and rehospitalisation among patients with chronic heart failure.

Purpose: To investigate the impacts of patient activation, self-efficacy, heart failure knowledge and medication adherence on rehospitalisation for chronic heart failure patients.

Methods: This was a secondary analysis of the longitudinal observational survey about factors influencing hospital readmission in chronic heart failure patients. A total of 432 participants were enlisted using convenience sampling from three university hospitals, Guangzhou, Southern China. The factors influencing rehospitalisation covered demographic and clinical variables, patient activation, heart failure knowledge, self-efficacy, and medication adherence. The univariate and multivariate logistic regression was used to examine the factors affecting hospital readmissions of chronic heart failure patients.

Result: The major factors influencing rehospitalisation for patients with chronic heart failure were as follows: poor NYHA function (OR=2.96, p=0.019), lower patient activation (OR=3.81, p<0.001), inadequate HF knowledge (OR=1.46, p=0.037), lower self-efficacy (OR=2.53, p<0.001), and non-adherence to medication (OR=2.28, p=0.011).

Conclusion: Poor cardiac function, lower activation, self-efficacy, inadequate heart failure knowledge and non-adherence to medication were associated with hospital readmissions in chronic heart failure patients, the findings indicate these factors should be underlined in preventing rehospitalisation in the population.

Keywords: Heart failure; Knowledge; Medication adherence; Patient activation;


Heart Failure (HF) is the end stage of heart disease and is found to be a leading reason for hospitalisation and readmission throughout the world, remains a significant burden on the family and health care system worldwide [1,2]. A number of evidences demonstrated that the hospital readmission is prevalent in patients with Chronic Heart Failure (CHF) after discharge within 30 days, three months and one year, which is a big challenge for health professional and health care system [3,4]. Therefore, it is beneficial to early identify factors influencing rehospitalisation for this population. The previous studies explored many factors impacting it, such as, demographic factors, clinical factors, and psychological factors, however, no studies focus on associations between patient activation, self-efficacy, HF knowledge, medication adherence and rehospitalisation among CHF patients.


Patient activation is defined as the knowledge, skills, beliefs, and behaviors that patients need to manage their own health and healthcare, to cooperate with health providers, to preserve their health functioning, and to access care appropriate to their conditions [5]. An individual’s level of activation may provide a gauge of his/her propensity to perform health behaviors that increase the chance of better health outcomes [6]. Emerging evidence reveals that patient activation is a factor that may predict hospitalisation, emergency room utilization in chronically ill populations [7,8]. HF is a long-term chronic condition, patients are required to have a high activation to conduct self-care behaviors, and they also need be motivated and involved in their health care [1,9]. Although many studies explored the levels of patient activation, the association between activation and health outcomes in patients with chronic diseases, yet little is known about what impacts of activation on hospital readmission in CHF patients. Self-efficacy is a key factor in determining health behaviors in healthy individuals or adults with chronic diseases. A number of studies show that increased self-efficacy has been related to improved medication adherence, physical activity, and self-care in patients with chronic illness [10,11]. Several studies report that lack of confidence is especially problematic for CHF patients during self-care after hospital discharge; they were prone not to take medication, and withdraw from cardiac rehabilitation program [11,12], which are common reasons for rehospitalisation in the population. Up to now, few studies investigated the effects of self-efficacy on hospital readmission in CHF patients.

The recent study demonstrates adequate HF knowledge is a major aspect for HF patients in maintaining clinical stability, avoiding illness exacerbation [13,14]. HF knowledge deficiency is a barrier to perform effective treatment management in the population [15]. It is identified that enhancing HF patients’ knowledge on pharmaceutical has clinical value in reducing re-hospitalisation and improving health outcomes [16]. Likewise, adequate HF knowledge of patients, including HF symptom, medication, self-care, and disease prevention could prevent illness progress and hospital readmission. HF patients encounter the complex medical regimens in exception of the long-term medication use; this is a big challenge for them to comply with medication regimen [17].

Optimal treatment adherence by HF patients maximises the benefits of therapy, and can alter disease trajectory, improve quality of life, and increase life expectancy [2]. Conversely, low adherence is related to poor health outcomes, such as reduced cardiac function, decline in daily life, and repeated hospital stays [1,18]. Prior studies have addressed the risk of hospitalisation related to medication non-adherence in adults with CHF [19]; however, the associations between hospital readmission and non-adherence to medication remain unclear in CHF patients. Despite a growing focus on hospital readmission and health outcomes in HF patients, the patient perspective on precipitating factors for rehospitalisation is not well-described [14]. As stated, above-mentioned studies, few data report the impacts of patient activation, self-efficacy, HF knowledge and medication adherence on rehospitalisation in CHF population. Therefore, the study was conducted aiming to analyses the associations between these variables and rehospitalisation in the population.


To determine the factors associated with rehospitalisation in CHF population, we analyzed data from a longitudinal observational study that has been described elsewhere [20]. The methodology of that study was summarized as following.


A longitudinal observational study was adopted in that study, which examined the factors influencing rehospitalisation for CHF patients after hospital discharge within six months in three tertiary University hospitals, Guangzhou, southern China. A convenience sampling method was used to enlist the participants. Data collection was conducted by authors from May 2015 to April 2016, the first data were gathered on the day before hospital discharge, and the second data were collected six months after baseline data collection. The study was approved by the Ethics Committee of Guangzhou Medical University (No. 15028). This study was reported based on strengthening the reporting of observational studies in epidemiology guideline.


The participants who met the following inclusion criteria were invited to attend the study:

  1. A confirmed diagnosis of chronic heart failure by the cardiologist,
  2. 18 years of age and older and
  3. Approval to participate in the study.

Participants were excluded if they:

  1. Were pregnant,
  2. Had severe cognitive or psychiatric impairments, and
  3. Could not speak mandarin or Cantonese. The calculation of sample size had been reported elsewhere [20].


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