Heart Failure Patients' Time, Symptoms, and Actions Before a Hospital Admission

The objective of this study was to compare newly diagnosed heart failure (HF) patients (n = 64) with chronic HF patients (n = 148) who had been hospitalized on their presenting symptoms and treatment delay times, whom the 2 groups notified and when, the advice they were given by those notified, and the actions they initiated before their hospitalization. Participants in the 2 groups similarly reported shortness of breath on exertion, orthopnea, weakness, edema, and cough, A greater percent of participants in the group with an HF history reported having fatigue compared to the group with no HF history (chi(2) = 4.32, P <.05). Both groups were similar in the time they spent with symptoms before hospital admission (median of 7 days), the time until they notified family members after symptom onset (6 hours to 1.5 days), and the time until they notified their physicians after symptom onset (1.5 to 3 days). The 2 groups varied significantly on the following findings: physicians advised participants with an HF history to call 911 significantly more often than they told the participants with no HF history to call 911 (chi(2) = 4.33, P <.05), physicians told those with no HF history to come to the office (chi(2) = 5.04, P <.05) or wait for an upcoming appointment (chi(2) = 4.78, P <.05) more often than they made those recommendations to the group with an HF history, and participants with an HF history were significantly more likely to call 911 than the participants with no HF history do (chi(2) = 4.18, P <.05). The clinical implication is that individuals with either new or worsening HF need to recognize a constellation of possible HF symptoms. Those with chronic HF need to also be aware that increasing fatigue may be an important symptom of worsening HF for them. Both groups of HF patients should report their symptoms promptly to their healthcare providers for early intervention.