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Does Oxygen Saturation or Distance Walked Predict Rehospitalization in Heart Failure?

Howie-Esquivel, Jill PhD, RN, NP; Dracup, Kathleen RN, DNSc, FNP, FAAN

The Journal of Cardiovascular Nursing: July-August 2008 - Volume 23 - Issue 4 - p 349-356
doi: 10.1097/01.JCN.0000317434.29339.14

Background: Hospitalized heart failure (HF) patients experience high rehospitalization rates. Predicting early rehospitalization risk in HF patients may enable better decision making at time of hospital discharge. It is known that sex and ethnicity influence rehospitalization rates. Several measures easily and conveniently obtained before discharge are arterial oxygen saturation (SaO2) and distance walked during the 6-minute walk test (6MWT).

Research Objective: The aim of this pilot study was to examine sociodemographic (sex and ethnicity) and clinical (oxygenation and distance walked) variables obtained during a predischarge 6MWT that could indicate increased risk of cardiac rehospitalization within 90 days.

Methods: Within 24 hours of discharge, 44 hospitalized HF patients underwent 6MWT with continuous SaO2 and heart rate monitoring. Demographic data, past medical history, and medication use were collected from the patients' charts.

Results: Participants' mean (SD) age was 59.6 (18.6) years, with half (n = 22) being Caucasian/white and one-quarter (n = 11) being married. Half (n = 22) were anemic on admission. Mean (SD) SaO2 was 94.2% (3.6%), mean (SD) minimum SaO2 was 89.1% (6.1%), and mean (SD) 6MWT was 220.8 (111.6) m. More than half (n = 23) were rehospitalized for cardiac reasons. Women had a 2.5 times greater risk of rehospitalization than men did. Women were significantly more anemic and walked shorter distances. There was no relation between distance walked or SaO2 and rehospitalization risk.

Conclusion: Although there was no relation between SaO2 and rehospitalization risk, women had a greater risk of rehospitalization, were more frail, and were more often anemic. This study is novel because it establishes a link between sex, anemia, functional status, and rehospitalization risk in patients hospitalized for HF. More research is needed to better understand the influence of anemia, functional status, and sex in relation to rehospitalization risk.

Jill Howie-Esquivel, PhD, RN, NP Associate Clinical Professor, Department of Physiological Nursing, University of California, San Francisco.

Kathleen Dracup, RN, DNSc, FNP, FAAN Dean and Professor, Department of Physiological Nursing, University of California, San Francisco.

This study was funded by the Hellman Family Foundation and the American Nurses' Association Fellowship. The Nonin equipment was donated to the investigators.

There are no disclosures.

Corresponding author Jill Howie-Esquivel, PhD, RN, NP, 2 Koret Way, Box 0610, School of Nursing, University of California, San Francisco, San Francisco, CA 94143 (

© 2008 Lippincott Williams & Wilkins, Inc.