This article is more than 5 years old. Information may no longer be current.
Score predicts 30-day death, readmission risk in patients with HF
A novel risk prediction model outperformed an existing model in predicting 30-day readmission or death in patients hospitalized for HF, according to a research letter published in JAMA Cardiology.
Unlike other prediction models, the new model includes factors such as echocardiographic results, mental health, cognitive function and socioeconomic status at the individual level, the researchers wrote.
Predicting readmission
“Readmission for HF remains common and the risk of this remains hard to predict,” researcher Thomas H. Marwick, MBBS, PhD, MPH, from Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia, and Baker IDI Heart and Diabetes Research Institute, Melbourne, told Cardiology Today. “It’s possible that existing risk scores don’t cover all important patient features.”
Quan L. Huynh, BMed, PhD, from Menzies Institute for Medical Research, and colleagues derived the score from a cohort of 430 patients with HF in Australia (median age, 74 years; 64% men) and validated it in a cohort of 161 patients with HF who had not been admitted for HF in at least 6 months (median age, 78 years; 55% men).
Huynh and colleagues assessed 29 potential predictors of 30-day death or readmission in patients with HF, and they included predictors in the model if they contributed at least 0.01 units to the area under the curve.
The predictors were living alone (OR = 2.05; 95% CI, 1.12-3.76), presence of life-threatening arrhythmia (OR = 2.92; 95% CI, 1.2-7.13), discharge during winter (OR = 1.61; 95% CI, 1-3.31), heart rate per 5 bpm (OR = 1.12; 95% CI, 1.01-1.24), NYHA classification (OR = 1.95; 95% CI, 1.35-2.84), Montreal Cognitive Assessment score (OR = 0.9; 95% CI, 0.86-0.95), Patient Health Questionnaire-9 score (OR = 1.04; 95% CI, 1-1.08), right atrial pressure (HR = 1.06; 95% CI, 1.01-1.12), left atrial volume index (OR = 1.02; 95% CI, 1.01-1.03), blood urea nitrogen (OR = 1.04; 95% CI, 1.01-1.08) and serum albumin (OR = 0.95; 95% CI, 0.91-0.99).
“We confirmed that cognitive impairment was an unmeasured contributor and incorporated this measurement in a prediction model,” Marwick said. “The resulting model was the most reliable reported to date and could be used to identify patients who need the closest follow-up to avoid readmission. Teaching patients about [HF] is crucial to preventing readmission, as we need to emphasize principles of self-care. This requires them to be cognitively intact.”
Discriminatory power
In the derivation cohort of 430 patients, within 30 days of discharge, 9% died and 21% were readmitted. The researchers wrote that the final prediction model showed good discrimination when predicting 30-day death or readmission (C statistic = 0.82; 95% CI, 0.77-0.87), 30-day death (C statistic = 0.83; 95% CI, 0.73-0.93) and 30-day readmission (C statistic, 0.8; 95% CI, 0.74-0.85).
The model had better discriminatory power than a claims-based model (C statistic = 0.56; 95% CI, 0.5-0.61), according to the researchers.
The model also strongly predicted 30-day death or readmission in the external validation cohort of 161 patients (C statistic = 0.8; 95% CI, 0.69-0.91), Huynh and colleagues wrote.
Marwick told Cardiology Today that future research should examine whether “there is any benefit from heightened surveillance,” as well as whether patients with cognitive impairment can benefit from additional teaching methods. “These steps to either enhance self-care or improve assistance may reduce readmission in these patients.” – by Erik Swain
For more information:
Thomas H. Marwick, MBBS, PhD, MPH, can be reached at Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Vic 3004, Australia; email: tom.marwick@bakeridi.edu.au.
Disclosure: The researchers report no relevant financial disclosures.