Factors contributing to the hospitalization of patients with congestive heart failure

Am J Public Health. 1997 Apr;87(4):643-8. doi: 10.2105/ajph.87.4.643.


Objectives: This study identifies acute precipitants of hospitalization and evaluates utilization of angiotension-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 > or = 180 mm Hg (15%), atrial arrhythmia with heart rate > or = 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 < or = 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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angina Pectoris / complications
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Blood Pressure
  • Cross-Sectional Studies
  • Female
  • Heart Failure / complications
  • Heart Failure / drug therapy
  • Heart Failure / physiopathology*
  • Heart Rate
  • Hospitalization*
  • Humans
  • Hypertension / complications
  • Male
  • Middle Aged
  • Respiratory Tract Infections / complications


  • Angiotensin-Converting Enzyme Inhibitors