Heart Failure Hospital Readmissions and Physical Therapy

The research plan is to investigate how acute physical therapy can play a big role in
lowering 30-day hospital readmission in patients discharged with acute decompensated heart
failure (ADHF). Several factors will be used to investigate and predict 30-day hospital
readmission. Such factors are (1) functional mobility; 2) psychosocial attributes; (3) number
of follow ups with providers; (4) adherence to home exercise program; (5) and participation
in a supervised exercise program. Functional mobility will be measured by four different
functional outcome measurements such as 5 meter walk test (5mWT), 30 seconds sit to stand
test (30STS), six minute walk test (6MWT), and time up and go test (TUG). The psychosocial
attributes will be measured by three different, pen and paper, self-survey questionnaires
namely Kansas City Cardiomyopathy Questionnaire-12 (KCCQ12), Hospital Anxiety and Depression
Scale (HADS), ENRICHD Social Support Instrument (ESSI). Moreover, once the patient returns
home, two phone surveys will be conducted (every two weeks) for a period of 30 days of
hospital discharge as a follow up.

For the outcome measurements, the 5mWT is a simple test to measure individual's gait
(walking) speed. The 30STS is a simple and easy test to complete in assessing functional
lower extremity strength. The 30STS asks individual to stand up (assuming erect posture as
much as possible with or without hands support) as many as possible from a regular chair with
arm rest within 30 seconds timeframe. The 6MWT is simple and practical test is to measure
aerobic capacity by measuring distance of an individual's ability to walk for 6 minutes. The
TUG is to measure the time in seconds for a person to rise from sitting from a standard arm
chair, rise, walk 10 feet, walk back to the previous arm chair, and sit down. The objective
of the TUG test is to classify patient's fall risk. In addition, the functional mobility,
basing on the functional outcome measures conducted, will be further assessed at the end of
physical therapy service at the hospital by using Global Rating of Scale (GROC). The GROC is
a self-survey using 5 point Likert scale, measuring how patient perceives the overall degree
of change of improvement or perhaps a lack of improvement.

For the Psychosocial Measures, the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 is a
shorter version of the original KCCQ tool. The objective of this test is to quantify
self-measurement of physical function, symptoms, social function, self-efficacy and
knowledge, and quality of life as it relates to their own heart failure diagnosis. The
Hospital Anxiety and Depression Scale (HADS) is a self-reported questionnaire designed to
measure the levels of anxiety and depression that an individual is experiencing. The
objective of this tool is to serve as a screening tool to identify individuals who may suffer
from anxiety and depression. The ENRICHD Social Support Instrument (ESSI) is a seven-item
self-report survey that assesses patient's belief of their social support attributes
(emotional, instrumental, informational, and appraisal).

Inclusion Criteria:

- all admitted at Houston Methodist Hospital with a primary diagnosis of acute heart
failure or similar type of medical diagnosis

- stable medical state (HR equal or greater than 50 bpm, mean BP of 60 mmHg or better,
Oxygen saturation (with or without oxygen supplement) of 90% or better; RR of 15 or
better

- 50 years old and over and able to follow 2 simple commands

- establish discharge recommendation to home settings

- ambulatory with or without assitive device(s)

Exclusion Criteria:

- history of psychiatric disorder

- diagnosis of acute kidney injury requiring continuous renal replacement therapy

- diagnosis of major cognitive impairment (dementia, Alzheimer's dse, etc)

- inability to read and understand basic english language

- establish discharge recommendation to post-acute care settings (e.g. SNF, inpatient
rehab, LTACH)

- inability to complete any functional mobility test due to musculoskeletal or other
disorders