Delay in seeking medical care for worsening heart failure symptoms: predictors and association with cardiac events

• Published in: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2021-06, Vol.20 (5), p.454-463
• Main Authors: Lin, Chin-Yen, Hammash, Muna, Miller, Jennifer L, Schrader, Melanie, Mudd-Martin, Gia, Biddle, Martha J, Moser, Debra K
• Format: Article
• Language: English
• Subjects: Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - therapy; Hospitalization; Humans; Patient Acceptance of Health Care - psychology
• ISSN: 1474-5151; 1873-1953
• DOI: 10.1093/eurjcn/zvaa032

Abstract Aims The association of delay in seeking medical care to subsequent cardiac events remains unknown in patients with worsening heart failure (HF) symptoms. The aims of this study were to (i) identify factors predicting care-seeking delay and (ii) examine the impact of care-seeking delay on subsequent cardiac rehospitalization or death. Methods and results We studied 153 patients hospitalized with an exacerbation of HF. Potential predictors of delay including demographic, clinical, psychosocial, cognitive, and behavioural variables were collected. Patients were followed for 3 months after discharge to determine time to the first cardiac rehospitalization or death. The median delay time was 134 h (25th and 75th percentiles 49 and 364 h). Non-linear regression showed that New York Heart Association functional class III/IV (P = 0.001), worse depressive symptoms (P = 0.004), better HF knowledge (P = 0.003), and lower perceived somatic awareness (P = 0.033) were predictors of delay time from patient perception of worsening HF to subsequent hospital admission. Cox regression revealed that patients who delayed longer (more than 134 h) had a 1.93-fold higher risk of experiencing cardiac events (P = 0.044) compared to non-delayers. Conclusions Care-seeking delay in patients with worsening HF symptoms was significantly associated with an increased risk of rehospitalization and mortality after discharge. Intervention strategies addressing functional status, psychological state, cognitive and behavioural factors are essential to reduce delay and thereby improve outcomes.