Shannon M Dunlay1, Joan M Griffin, Margaret M Redfield, Véronique L Roger. 1. Shannon M. Dunlay, MD, MS Associate Professor, Division of Cardiovascular Diseases, Department of Medicine, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. Joan M. Griffin, PhD Associate Professor, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. Margaret M. Redfield, MD Professor, Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota. Véronique L. Roger, MD, MPH Professor of Epidemiology, Division of Cardiovascular Diseases, Department of Medicine, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND: Recent data suggest that patient activation, or having the knowledge, skills, and confidence to engage and manage one's own health, favorably impacts patient behaviors and health outcomes. However, the role of activation in patients with heart failure is unknown. OBJECTIVES: The aims of this study are to measure the level of activation of patients hospitalized with acute decompensated heart failure (ADHF) and to determine whether activation is associated with in-hospital and early postdischarge outcomes. METHODS: We prospectively recruited Southeastern Minnesota residents hospitalized at Mayo Clinic hospitals with ADHF from January 2014 to July 2015. Activation was measured using the Patient Activation Measure questionnaire. RESULTS: Among the 302 patients enrolled, the mean age was 77.3 years, 57.3% were men, and 46.8% had preserved ejection fraction. The median (25th-75th percentile) length of stay was 4 (3-7) days. In total, 7 (2.3%) patients died before discharge. Most survivors were discharged to home (73.6%) or skilled nursing facilities (23.7%). The number of patients in each activation level from highest to lowest was 9 (3.0%), 121 (40.1%), 122 (40.4%), and 50 (16.6%). Patients with lower activation were older, were less educated, had lower patient satisfaction, and had worse health literacy. They were more often discharged to skilled nursing facilities and had higher 30-day mortality, although 30-day readmission did not differ by activation. CONCLUSIONS: Patients hospitalized with ADHF with lower activation are less satisfied, have worse health literacy, more often require skilled care, and are at increased risk for early postdischarge mortality. Activation can be easily measured and may help clinicians identify high-risk patients.
BACKGROUND: Recent data suggest that patient activation, or having the knowledge, skills, and confidence to engage and manage one's own health, favorably impacts patient behaviors and health outcomes. However, the role of activation in patients with heart failure is unknown. OBJECTIVES: The aims of this study are to measure the level of activation of patients hospitalized with acute decompensated heart failure (ADHF) and to determine whether activation is associated with in-hospital and early postdischarge outcomes. METHODS: We prospectively recruited Southeastern Minnesota residents hospitalized at Mayo Clinic hospitals with ADHF from January 2014 to July 2015. Activation was measured using the Patient Activation Measure questionnaire. RESULTS: Among the 302 patients enrolled, the mean age was 77.3 years, 57.3% were men, and 46.8% had preserved ejection fraction. The median (25th-75th percentile) length of stay was 4 (3-7) days. In total, 7 (2.3%) patients died before discharge. Most survivors were discharged to home (73.6%) or skilled nursing facilities (23.7%). The number of patients in each activation level from highest to lowest was 9 (3.0%), 121 (40.1%), 122 (40.4%), and 50 (16.6%). Patients with lower activation were older, were less educated, had lower patient satisfaction, and had worse health literacy. They were more often discharged to skilled nursing facilities and had higher 30-day mortality, although 30-day readmission did not differ by activation. CONCLUSIONS:Patients hospitalized with ADHF with lower activation are less satisfied, have worse health literacy, more often require skilled care, and are at increased risk for early postdischarge mortality. Activation can be easily measured and may help clinicians identify high-risk patients.
Authors: Jennifer L St Sauver; Brandon R Grossardt; Cynthia L Leibson; Barbara P Yawn; L Joseph Melton; Walter A Rocca Journal: Mayo Clin Proc Date: 2012-02 Impact factor: 7.616
Authors: Richard L Skolasky; Ariel Frank Green; Daniel Scharfstein; Chad Boult; Lisa Reider; Stephen T Wegener Journal: Health Serv Res Date: 2010-11-19 Impact factor: 3.402
Authors: Clyde W Yancy; Mariell Jessup; Biykem Bozkurt; Javed Butler; Donald E Casey; Mark H Drazner; Gregg C Fonarow; Stephen A Geraci; Tamara Horwich; James L Januzzi; Maryl R Johnson; Edward K Kasper; Wayne C Levy; Frederick A Masoudi; Patrick E McBride; John J V McMurray; Judith E Mitchell; Pamela N Peterson; Barbara Riegel; Flora Sam; Lynne W Stevenson; W H Wilson Tang; Emily J Tsai; Bruce L Wilkoff Journal: J Am Coll Cardiol Date: 2013-06-05 Impact factor: 24.094
Authors: Serguei Pakhomov; Susan A Weston; Steven J Jacobsen; Christopher G Chute; Ryan Meverden; Véronique L Roger Journal: Am J Manag Care Date: 2007-06 Impact factor: 2.229
Authors: Larry A Allen; Adrian F Hernandez; Eric D Peterson; Lesley H Curtis; David Dai; Frederick A Masoudi; Deepak L Bhatt; Paul A Heidenreich; Gregg C Fonarow Journal: Circ Heart Fail Date: 2011-03-29 Impact factor: 8.790
Authors: Pamela N Peterson; Susan M Shetterly; Christina L Clarke; David B Bekelman; Paul S Chan; Larry A Allen; Daniel D Matlock; David J Magid; Frederick A Masoudi Journal: JAMA Date: 2011-04-27 Impact factor: 56.272
Authors: Suzanne E Mitchell; Paula M Gardiner; Ekaterina Sadikova; Jessica M Martin; Brian W Jack; Judith H Hibbard; Michael K Paasche-Orlow Journal: J Gen Intern Med Date: 2013-10-04 Impact factor: 5.128
Authors: Daniel David; Deborah E Barnes; Ryan D McMahan; Ying Shi; Mary T Katen; Rebecca L Sudore Journal: J Palliat Med Date: 2018-08-21 Impact factor: 2.947
Authors: Nathaniel A Erskine; Barbara Gandek; Molly E Waring; Rebecca L Kinney; Darleen M Lessard; Randolph S Devereaux; Stavroula A Chrysanthopoulou; Catarina I Kiefe; Robert J Goldberg Journal: J Cardiovasc Nurs Date: 2018 Mar/Apr Impact factor: 2.083
Authors: Uday Narayan Yadav; Jane Lloyd; Hassan Hosseinzadeh; Kedar Prasad Baral; Narendra Bhatta; Mark Fort Harris Journal: BMC Public Health Date: 2020-03-06 Impact factor: 3.295
Authors: Gabbi Frith; Kathryn Carver; Sarah Curry; Alan Darby; Anna Sydes; Stephen Symonds; Katrina Wilson; Gordon McGregor; Kevin Auton; Simon Nichols Journal: BMC Health Serv Res Date: 2021-12-24 Impact factor: 2.655
Authors: Pamela J McCabe; Lynette G Stuart-Mullen; Christopher J McLeod; Thomas O Byrne; Monika M Schmidt; Megan E Branda; Joan M Griffin Journal: Patient Prefer Adherence Date: 2018-09-25 Impact factor: 2.711