Pharmacy World & Science

, Volume 31, Issue 5, pp 572–579 | Cite as

Heart failure exacerbation leading to hospital admission: a cross-sectional study

  • Elin C. LehnbomEmail author
  • Anna C. Bergkvist
  • Klas Gränsbo
Research Article


Objectives The aim of this pilot study was to investigate cause(s) of heart failure (HF). Setting The emergency department and medical wards at Malmö University Hospital. Method A cross sectional pilot study. Main outcome measures Comparison of compliance, comprehension and optimal treatment on a population basis between men and women, younger (≤75 years) and elderly (>75 years) patients, and patients in different New York Heart Association (NYHA) classes, in order to assess if exacerbation could have been caused by any of these factors. Results Of the 47 patients included, 60% reported high compliance, with significant differences between women and men, and between patients in NYHA class IV and patients in NYHA class III. Comprehension on self-care was poor. Only 30% weighed themselves regularly and 45% did not limit the amount of fluids. No more than 28% reported they would contact a health professional in the case of experiencing more symptoms. Suboptimal treatment was also found to be a great concern. The majority were treated with recommended agents, but had not achieved target dose as recommended in the guidelines. Conclusion This pilot study indicates suboptimal HF management of patients with HF prior to hospital admission due to HF exacerbation. A larger study is needed to assess the extent of the problem, and establish the need and nature of management improvement in different patient subgroups.


Adherence Compliance Heart failure Hospital admission Self-care Sub-optimal treatment Sweden 



The authors would like to thank Steve Hudson and Tobias Dreishulte at the University of Strathclyde for their help in designing the project protocol and for providing us with the Scottish MAT and Tommy Eriksson at the University of Uppsala for valuable feedback. We would also like to thank the staff at the Emergency Department and the internal medical wards where this pilot study was conducted.


EL was supported in part through a scholarship from the Swedish Pharmaceutical Association.

Conflicts of Interest

The authors have no conflicts of interest to declare.


  1. 1.
    Behandlingsrekommendation: diagnostik och behandling av kronisk hjärtsvikt [Treatment recommendation: diagnosis and treatment of heart failure]. Swedish Medical Products Agency 2006:(17)1. Available at: Accessed 16 Feb 2009.
  2. 2.
    Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29:2388–442.CrossRefPubMedGoogle Scholar
  3. 3.
    Classification of Functional Capacity and Objective Assessment. American Heart Association; [cited 16 Feb 2009]; Available from:
  4. 4.
    Cowie MR, Wood DA, Coats AJ, Thompson SG, Suresh V, Poole-Wilson PA, et al. Survival of patients with a new diagnosis of heart failure: a population based study. Heart. 2000;83:505–10.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    McMurray JJ, Stewart S. Epidemiology, aetiology, and prognosis of heart failure. Heart. 2000;83:596–602.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Michalsen A, Konig G, Thimme W. Preventable causative factors leading to hospital admission with decompensated heart failure. Heart. 1998;80:437–41.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    van der Wal MH, Jaarsma T, van Veldhuisen DJ. Non-compliance in patients with heart failure; how can we manage it? Eur J Heart Fail. 2005;7:5–17.CrossRefPubMedGoogle Scholar
  8. 8.
    van der Wal MH, Jaarsma T, Moser DK, Veeger NJ, van Gilst WH, van Veldhuisen DJ. Compliance in heart failure patients: the importance of knowledge and beliefs. Eur Heart J. 2006;27:434–40.CrossRefPubMedGoogle Scholar
  9. 9.
    Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, et al. Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med. 2007;146:714–25.CrossRefPubMedGoogle Scholar
  10. 10.
    Hope CJ, Wu J, Tu W, Young J, Murray MD. Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure. Am J Health Syst Pharm. 2004;61:2043–9.PubMedGoogle Scholar
  11. 11.
    Morrow DG, Weiner M, Young J, Steinley D, Deer M, Murray MD. Improving medication knowledge among older adults with heart failure: a patient-centered approach to instruction design. Gerontologist. 2005;45:545–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Carlson B, Riegel B, Moser DK. Self-care abilities of patients with heart failure. Heart Lung. 2001;30:351–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Jaarsma T, Stromberg A, Martensson J, Dracup K. Development and testing of the European Heart Failure Self-Care Behaviour Scale. Eur J Heart Fail. 2003;5:363–70.CrossRefPubMedGoogle Scholar
  14. 14.
    Pont LG, van Gilst WH, Lok DJ, Kragten HJ, Haaijer-Ruskamp FM. The relevance of heart failure severity for treatment with evidence-based pharmacotherapy in general practice. Eur J Heart Fail. 2003;5:187–93.CrossRefPubMedGoogle Scholar
  15. 15.
    McMurray JJ, Ostergren J, Swedberg K, Granger CB, Held P, Michelson EL, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-added trial. Lancet. 2003;362:767–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Krum H, Carson P, Farsang C, Maggioni AP, Glazer RD, Aknay N, et al. Effect of valsartan added to background ACE inhibitor therapy in patients with heart failure: results from Val-HeFT. Eur J Heart Fail. 2004;6:937–45.CrossRefPubMedGoogle Scholar
  17. 17.
    ESCP 36th European Symposium on Clinical Pharmacy ‘Implementing Clinical Pharmacy in Community and Hospital Settings: Sharing the Experience’, Istanbul, Turkey 25–27 Oct 2007; Abstracts. Pharm World Sci. 2008;30.Google Scholar
  18. 18.
    Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74.CrossRefPubMedGoogle Scholar
  19. 19.
    Holst M, Willenheimer R, Martensson J, Lindholm M, Stromberg A. Telephone follow-up of self-care behaviour after a single session education of patients with heart failure in primary health care. Eur J Cardiovasc Nurs. 2007;6:153–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Maison P, Cunin P, Hemery F, Fric F, Elie N, Del’volgo A, et al. Utilisation of medications recommended for chronic heart failure and the relationship with annual hospitalisation duration in patients over 75 years of age. A pharmacoepidemiological study. Eur J Clin Pharmacol. 2005;61:445–51.CrossRefPubMedGoogle Scholar
  21. 21.
    Haynes RB, Yao X, Degani A, Kripalani S, Garg A, McDonald HP. Interventions to enhance medication adherence. Cochrane Database Syst Rev. 2005; (4):CD000011.Google Scholar
  22. 22.
    Khunti K, Stone M, Paul S, Baines J, Gisborne L, Farooqi A, et al. Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: a cluster randomised controlled trial. Heart. 2007;93:1398–405.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bungard TJ, McAlister FA, Johnson JA, Tsuyuki RT. Underutilisation of ACE inhibitors in patients with congestive heart failure. Drugs. 2001;61:2021–33.CrossRefPubMedGoogle Scholar
  24. 24.
    Stromberg A, Martensson J, Fridlund B, Levin LA, Karlsson JE, Dahlstrom U. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial. Eur Heart J. 2003;24:1014–23.CrossRefPubMedGoogle Scholar
  25. 25.
    Sadik A, Yousif M, McElnay JC. Pharmaceutical care of patients with heart failure. Br J Clin Pharmacol. 2005;60:183–93.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Elin C. Lehnbom
    • 1
    • 2
    Email author
  • Anna C. Bergkvist
    • 3
  • Klas Gränsbo
    • 4
  1. 1.Therapeutics CentreSt Vincent’s HospitalDarlinghurstAustralia
  2. 2.Division of Pharmacokinetics and Drug Therapy, Department of Pharmaceutical BiosciencesUppsala UniversityUppsalaSweden
  3. 3.Hospital PharmacyUniversity Hospital MASMalmöSweden
  4. 4.Department of Internal MedicineUniversity Hospital MASMalmöSweden

Personalised recommendations