Nursing ETDs

Publication Date

9-9-2010

Abstract

Heart failure (HF) is a syndrome that primarily affects the aged and is the most common hospital discharge diagnosis for adults in the United States. Readmission is common following discharge from an acute hospital stay for HF. Patients with HF suffer more depressive morbidity than other patients with cardiovascular disease, and many age 65 or older experience social isolation. This prospective exploratory study examined whether readmission within 30 to 60 days of discharge from an index hospitalization for HF was associated with depressive symptoms or social isolation. A convenience sample of 101 patients participated during an index hospitalization for HF. Participants were followed-up for any readmissions within 30 or 60 days of discharge. Depressive symptoms were measured with the 15-item Geriatric Depression Scale (GDS-15) and social isolation with the Lubben Social Network Scale (LSNS). At least one readmission for HF occurred for 27 participants within 30 days and for 31 within 60 days. Cronbachs alpha for the GDS-15 was extremely low (.39), and few participants (n = 9) had scores consistent with risk for depression; hence, GDS-15 scores were inadequate for testing any association with readmission. The LSNS was reliable (alpha = .77), and 13 participants (13%) had scores consistent with social isolation. There was no association between social isolation and readmission within 30 or 60 days. However, responses to the LSNS helped to identify several patients whose need for social services had not been identified by hospital staff. In exploratory analyses, b-type natriuretic peptide (BNP) within 24 hours of the index admission was associated with readmission, median = 3327 vs. 852 pg/ml, p=.056, and 3782 vs. 845 pg ml, p=.016 for any vs. no readmission within 30 or 60 days, respectively. Limitations include convenience sampling and possible sampling bias as well as a relatively brief follow-up period. Despite the lack of association with readmission, there may be other reasons for screening patients hospitalized for HF for depression or social isolation. The association between BNP and readmission merits further investigation in a study designed for that purpose.

Degree Name

Nursing

Level of Degree

Doctoral

Department Name

College of Nursing

First Advisor

Parshall, Mark

First Committee Member (Chair)

Escandon, Socorro

Second Committee Member

Brooks, Annette

Third Committee Member

Schuster, Geoff

Fourth Committee Member

Stidley, Christine

Keywords

social isolation, depression

Language

English

Document Type

Dissertation

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