Pain, Return to Community Status, and 90-Day Mortality Among Hospitalized Patients With Heart Failure.
Asa B Smith, Miyeon Jung, Daniel O'Donnell and 2 others
PMID 38915135WHAT IT FOUND
Patients hospitalized with heart failure who had a pain diagnosis at discharge were less likely to return home or community, even after accounting for age, comorbidities, symptoms, and length of stay.
Pain did not predict 90-day mortality.
Key findings
01In the adjusted model, a diagnosis of pain predicted 26% decreased odds of returning to community.
02Pain at discharge was not significantly associated with 90-day mortality: 5.5% of patients with pain died versus 5.3% without pain, and the adjusted odds ratio was 1.08.
03A pain diagnosis was recorded at discharge for 523 of 2,169 patients, or 24.1% of the sample.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The pain variable was a hospital discharge diagnosis code, so it could not distinguish acute pain from chronic pain, pain severity, cause, or treatment received. The study used existing EMS and hospital records, so it could not fully account for reasons for hospitalization, heart failure severity, inpatient complications, medications, rehospitalization, or socioeconomic factors. All patients were transported by EMS to the emergency department and came from three Midwestern hospitals in a metropolitan area, so results may not apply to patients who arrive by other means or in other settings. Only 117 deaths occurred, which forced the mortality model to use fewer covariates and may have made it hard to detect a true association.
The easy way to misread this
Do not conclude that treating pain at discharge will improve return to community or mortality. This was an observational study using hospital diagnosis codes, not a treatment trial, and it did not measure pain severity, acute versus chronic pain, or the care patients received.