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Cai J, Huang D, Abdul Kadir HB, Huang Z, Ng LC, Ang A, Tan NC, Bee YM, Tay WY, Tan CS, Lim CC. Hospital Readmissions for Fluid Overload among Individuals with Diabetes and Diabetic Kidney Disease: Risk Factors and Multivariable Prediction Models. Nephron Clin Pract 2024; 148:523-535. [PMID: 38447535 PMCID: PMC11332313 DOI: 10.1159/000538036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
AIMS Hospital readmissions due to recurrent fluid overload in diabetes and diabetic kidney disease can be avoided with evidence-based interventions. We aimed to identify at-risk patients who can benefit from these interventions by developing risk prediction models for readmissions for fluid overload in people living with diabetes and diabetic kidney disease. METHODS This was a single-center retrospective cohort study of 1,531 adults with diabetes and diabetic kidney disease hospitalized for fluid overload, congestive heart failure, pulmonary edema, and generalized edema between 2015 and 2017. The multivariable regression models for 30-day and 90-day readmission for fluid overload were compared with the LACE score for discrimination, calibration, sensitivity, specificity, and net reclassification index (NRI). RESULTS Readmissions for fluid overload within 30 days and 90 days occurred in 8.6% and 17.2% of patients with diabetes, and 8.2% and 18.3% of patients with diabetic kidney disease, respectively. After adjusting for demographics, comorbidities, clinical parameters, and medications, a history of alcoholism (HR 3.85, 95% CI: 1.41-10.55) and prior hospitalization for fluid overload (HR 2.50, 95% CI: 1.26-4.96) were independently associated with 30-day readmission in patients with diabetic kidney disease, as well as in individuals with diabetes. Additionally, current smoking, absence of hypertension, and high-dose intravenous furosemide were also associated with 30-day readmission in individuals with diabetes. Prior hospitalization for fluid overload (HR 2.43, 95% CI: 1.50-3.94), cardiovascular disease (HR 1.44, 95% CI: 1.03-2.02), eGFR ≤45 mL/min/1.73 m2 (HR 1.39, 95% CI: 1.003-1.93) was independently associated with 90-day readmissions in individuals with diabetic kidney disease. Additionally, thiazide prescription at discharge reduced 90-day readmission in diabetic kidney disease, while the need for high-dose intravenous furosemide predicted 90-day readmission in diabetes. The clinical and clinico-psychological models for 90-day readmission in individuals with diabetes and diabetic kidney disease had better discrimination and calibration than the LACE score. The NRI for the clinico-psychosocial models to predict 30- and 90-day readmissions in diabetes was 22.4% and 28.9%, respectively. The NRI for the clinico-psychosocial models to predict 30- and 90-day readmissions in diabetic kidney disease was 5.6% and 38.9%, respectively. CONCLUSION The risk models can potentially be used to identify patients at risk of readmission for fluid overload for evidence-based interventions, such as patient education or transitional care programs to reduce preventable hospitalizations.
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Affiliation(s)
- Jiashen Cai
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Dorothy Huang
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Zhihua Huang
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- Specialty Nursing, Singapore General Hospital, Singapore, Singapore
| | - Li Choo Ng
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- Specialty Nursing, Singapore General Hospital, Singapore, Singapore
| | - Andrew Ang
- SingHealth Polyclinics, Singapore, Singapore
| | | | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Wei Yi Tay
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
| | - Chieh Suai Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Cynthia C. Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
- Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Kang Y, Stoddard G, Stehlik J, Stephens C, Facelli J, Gouripeddi R, Horne BD. Developing 60-Day Readmission Risk Score among Home Healthcare Patients with Heart Failure. Home Healthc Now 2024; 42:42-51. [PMID: 38190163 DOI: 10.1097/nhh.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Heart failure (HF) readmissions are common, costly, and often preventable. Despite the implementation of HF programs across clinical settings, rehospitalization is still common. Efforts to identify risk factors for 60-day rehospitalization among HF patients exist, but risk scoring has not been utilized in home healthcare. The purpose of this study was to develop a 60-day rehospitalization risk score for home care patients with HF. This study is a secondary data analysis of a retrospective cross-sectional dataset that was composed of data using the Outcome Assessment Information Set (OASIS)-C version for patients with HF. We computed the Charlson Comorbidity Index (CCI) to use as a confounder. The risk score was computed from the final logistic regression model regression coefficients. The median age was 78 years old, 45.4% were male, and 81.0% were White. We identified 10 significant risk factors including CCI score. The risk score achieved a c-statistic of 0.70 in this patient sample. This risk score could prove useful in clinical practice for guiding attention and decision-making for personalized care of patients with unrecognized or under-treated health needs.
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Tong R, Zhu Z, Ling J. Comparison of linear and non-linear machine learning models for time-dependent readmission or mortality prediction among hospitalized heart failure patients. Heliyon 2023; 9:e16068. [PMID: 37215773 PMCID: PMC10192765 DOI: 10.1016/j.heliyon.2023.e16068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
Although many models are available to predict prognosis of heart failure patients, most tools combining survival analysis are based on proportional hazard model. Non-linear machine learning algorithms would overcome the limitation of the time-independent hazard ratio assumption and provide more information in readmission or mortality prediction among heart failure patients. The present study collected the clinical information of 1796 hospitalized heart failure patients surviving during hospitalization in a Chinese clinical center from December 2016 to June 2019. A traditional multivariate Cox regression model and three machine learning survival models were developed in derivation cohort. Uno's concordance index and integrated Brier score in validation cohort were calculated to evaluate the discrimination and calibration of different models. Time-dependent AUC and Brier score curves were plotted to assess the performance of models at different time phases.
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Kinoshita M, Saito M, Inoue K, Nakagawa H, Fujimoto K, Sato S, Ikeda S, Sumimoto T, Yamaguchi O. Role of the right ventricular contractile reserve during low-load exercise in predicting heart failure readmission. J Cardiol 2023:S0914-5087(23)00049-7. [PMID: 36898666 DOI: 10.1016/j.jjcc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Exercise intolerance in patients with heart failure (HF) increases HF-associated readmission, and right ventricular (RV) contractile reserve assessed by low-load exercise stress echocardiography (ESE) is associated with exercise intolerance. This study investigated the impact of RV contractile reserve evaluated by low-load ESE on HF readmission. METHODS We prospectively examined 81 consecutive patients hospitalized for HF who underwent low-load ESE under a stabilized HF condition between May 2018 and September 2020. We performed a 25-W low-load ESE and defined RV contractile reserve as the increment in RV systolic velocity (RV s'). The primary outcome was hospital readmission. Incremental values of the change in RV s' over a readmission risk (RR) score were analyzed using the receiver operating characteristic (ROC) area under the curve; internal validation using bootstrapping was performed. The association between RV contractile reserve and HF readmission was illustrated with the Kaplan-Meier curve. RESULTS Eighteen (22 %) patients were readmitted due to worsening HF during the observation period (median 15.6 months). The cut-off value of 0.68 cm/s for the change in RV s' to predict HF readmission with the ROC curve analysis indicated good sensitivity (100 %) and specificity (76.2 %). The discriminatory ability for HF readmission was significantly improved by adding the change in RV s' to the RR score (p = 0.006), and the c-statistic using the bootstrap method was 0.92. The cumulative survival rate free of HF readmission was significantly lower in patients with reduced-RV contractile reserve (log-rank test, p < 0.001). CONCLUSIONS The change in RV s' during low-load exercise had an incremental prognostic value for predicting HF readmission. The results demonstrated the loss of RV contractile reserve assessed by low-load ESE was associated with HF readmission.
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Affiliation(s)
- Masaki Kinoshita
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan.
| | - Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Hirohiko Nakagawa
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan
| | - Kaori Fujimoto
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan
| | - Sumiko Sato
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
| | - Takumi Sumimoto
- Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan
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Sall F, Adoubi A, Boka C, Koffi N, Ouattara P, Dakoi A, Anzouan-Kacou JB. Post discharge management of heart failure patients: clinical findings at the first medical visit in a single-center study. BMC Cardiovasc Disord 2023; 23:94. [PMID: 36803293 PMCID: PMC9940359 DOI: 10.1186/s12872-023-03113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 02/06/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The Post Discharge Management of patients with heart failure impact significantly their incomes. This study aims to analyze the clinical findings and management at the first medical visit of these patients in our context. MATERIAL AND METHODS This is a retrospective cross-sectional descriptive study on consecutive files of patients hospitalized for heart failure from January to December 2018 in our Department. We analyse data from the first post discharge medical visit including medical visit time, clinical conditions and management. RESULTS Three hundred and eight patients (mean age: 53.4 ± 17.0 years, 60% males) were hospitalized on median duration of 4 days [1-22 days]. One hundred and fifty-three patients (49,67%) were presented at the first medical visit after 66.53 days[0.06-369] on average, 10 (3.24%) patients died before this first medical visit and 145 (47.07%) had been lost to follow-up. The re-hospitalization and treatment non-compliance rates were 9.4% and 3.6%, respectively. Male gender (p = 0.048), renal failure (p = 0.010), and Vitamin K antagonist (VKA) /direct oral anticoagulant (DOAC) (p = 0.049) were the main lost to follow-up factors in univariate analysis without statistic signification in multivariate analysis. Hyponatremia (OR = 2.339; CI 95% = 0.908-6.027; p = 0.020) and atrial fibrillation (OR = 2.673; CI 95% = 1.321-5.408; p = 0.012) were the major mortality factors. CONCLUSION The management of patients with heart failure after discharge from hospital seems to be insufficient and inadequate. A specialized unit is required to optimize this management.
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Affiliation(s)
- F Sall
- Université Alassane Ouattara, Bouake, Côte d'Ivoire.
| | - A Adoubi
- Université Alassane Ouattara, Bouake, Côte d'Ivoire
| | - C Boka
- Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - N Koffi
- Université Alassane Ouattara, Bouake, Côte d'Ivoire
| | - P Ouattara
- Université Alassane Ouattara, Bouake, Côte d'Ivoire
| | - A Dakoi
- Université Alassane Ouattara, Bouake, Côte d'Ivoire
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Wei D, Sun Y, Chen R, Meng Y, Wu W. The Charlson comorbidity index and short-term readmission in patients with heart failure: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e32953. [PMID: 36820540 PMCID: PMC9907905 DOI: 10.1097/md.0000000000032953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
The relationship between the Charlson comorbidity index (CCI) and short-term readmission is as yet unknown. Therefore, we aimed to investigate whether the CCI was independently related to short-term readmission in patients with heart failure (HF) after adjusting for other covariates. From December 2016 to June 2019, 2008 patients who underwent HF were enrolled in the study to determine the relationship between CCI and short-term readmission. Patients with HF were divided into 2 categories based on the predefined CCI (low < 3 and high > =3). The relationships between CCI and short-term readmission were analyzed in multivariable logistic regression models and a 2-piece linear regression model. In the high CCI group, the risk of short-term readmission was higher than that in the low CCI group. A curvilinear association was found between CCI and short-term readmission, with a saturation effect predicted at 2.97. In patients with HF who had CCI scores above 2.97, the risk of short-term readmission increased significantly (OR, 2.66; 95% confidence interval, 1.566-4.537). A high CCI was associated with increased short-term readmission in patients with HF, indicating that the CCI could be useful in estimating the readmission rate and has significant predictive value for clinical outcomes in patients with HF.
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Affiliation(s)
- Dongmei Wei
- Department of Cardiovascular, Guangzhou University of Chinese Medicine First Affiliated Hospital, Guangzhou, China
- Department of Cardiovascular, Liuzhou Traditional Chinese Medical Hospital, Liuzhou, China
| | - Yang Sun
- Guangxi University of Chinese Medicine, Nanning, China
| | - Rongtao Chen
- Guangxi University of Chinese Medicine, Nanning, China
| | - Yuanting Meng
- Guangxi University of Chinese Medicine, Nanning, China
| | - Wei Wu
- Department of Cardiovascular, Guangzhou University of Chinese Medicine First Affiliated Hospital, Guangzhou, China
- * Correspondence: Wei Wu, Department of Cardiovascular, Guangzhou University of Chinese Medicine First Affiliated Hospital, Guangzhou 510405, China (e-mail: )
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7
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Cornhill AK, Dykstra S, Satriano A, Labib D, Mikami Y, Flewitt J, Prosio E, Rivest S, Sandonato R, Howarth AG, Lydell C, Eastwood CA, Quan H, Fine N, Lee J, White JA. Machine Learning Patient-Specific Prediction of Heart Failure Hospitalization Using Cardiac MRI-Based Phenotype and Electronic Health Information. Front Cardiovasc Med 2022; 9:890904. [PMID: 35783851 PMCID: PMC9245012 DOI: 10.3389/fcvm.2022.890904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHeart failure (HF) hospitalization is a dominant contributor of morbidity and healthcare expenditures in patients with systolic HF. Cardiovascular magnetic resonance (CMR) imaging is increasingly employed for the evaluation of HF given capacity to provide highly reproducible phenotypic markers of disease. The combined value of CMR phenotypic markers and patient health information to deliver predictions of future HF events has not been explored. We sought to develop and validate a novel risk model for the patient-specific prediction of time to HF hospitalization using routinely reported CMR variables, patient-reported health status, and electronic health information.MethodsStandardized data capture was performed for 1,775 consecutive patients with chronic systolic HF referred for CMR imaging. Patient demographics, symptoms, Health-related Quality of Life, pharmacy, and routinely reported CMR features were provided to both machine learning (ML) and competing risk Fine-Gray-based models (FGM) for the prediction of time to HF hospitalization.ResultsThe mean age was 59 years with a mean LVEF of 36 ± 11%. The population was evenly distributed between ischemic (52%) and idiopathic non-ischemic cardiomyopathy (48%). Over a median follow-up of 2.79 years (IQR: 1.59–4.04) 333 patients (19%) experienced HF related hospitalization. Both ML and competing risk FGM based models achieved robust performance for the prediction of time to HF hospitalization. Respective 90-day, 1 and 2-year AUC values were 0.87, 0.83, and 0.80 for the ML model, and 0.89, 0.84, and 0.80 for the competing risk FGM-based model in a holdout validation cohort. Patients classified as high-risk by the ML model experienced a 34-fold higher occurrence of HF hospitalization at 90 days vs. the low-risk group.ConclusionIn this study we demonstrated capacity for routinely reported CMR phenotypic markers and patient health information to be combined for the delivery of patient-specific predictions of time to HF hospitalization. This work supports an evolving migration toward multi-domain data collection for the delivery of personalized risk prediction at time of diagnostic imaging.
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Affiliation(s)
- Aidan K. Cornhill
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Steven Dykstra
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Alessandro Satriano
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Dina Labib
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Yoko Mikami
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Jacqueline Flewitt
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Easter Prosio
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Sandra Rivest
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Rosa Sandonato
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
| | - Andrew G. Howarth
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Carmen Lydell
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Cathy A. Eastwood
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nowell Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Joon Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Science, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James A. White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, AB, Canada
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- *Correspondence: James A. White,
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Muñoz MA, Calero E, Duran J, Navas E, Alonso S, Argemí N, Casademunt M, Furió P, Casajuana E, Torralba N, Farre N, Abellana R, Verdú-Rotellar JM. Short-Term Mortality in Patients with Heart Failure at the End-of-Life Stages: Hades Study. J Clin Med 2022; 11:jcm11092280. [PMID: 35566406 PMCID: PMC9101156 DOI: 10.3390/jcm11092280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Information regarding short-term vital prognosis in patients with heart failure at advanced stages of the disease is scarce. Objective: To develop a three-month mortality predictive model for patients with advanced heart failure. Methods: Prospective observational study carried out in primary care and a convalescence community facility. Heart failure patients either New York Heart Association (NYHA) III with at least two HF hospitalizations during the previous six months or NYHA IV with/without previous recent hospitalization were included in the study. Multivariable predictive models using Cox regression were performed. Results: Of 271 patients included, 55 (20.3%) died during the first three months of follow-up. Mean age was 84.2 years (SD 8.3) and 59.8% were women. Predictive model including NT-proBNP had a C-index of 0.78 (95% CI 0.71; 0.85) and identified male gender, low body mass index, high potassium and NT-proBNP levels, and moderate-to-severe dependence for daily living activities (Barthel index < 40) as risk factors of mortality. In the model without NT-proBNP, C index was 0.72 (95% CI 0.64; 0.79) and, in addition to gender, body mass index, low Barthel index, and severe reductions in glomerular filtration rate showed the highest predictive hazard ratios for short-term mortality. Conclusions: In addition to age, male gender, potassium levels, low body mass index, and low glomerular filtration, dependence for activities of daily living add strong power to predict mortality at three months in patients with advanced heart failure.
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Affiliation(s)
- Miguel Angel Muñoz
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain; (S.A.); (N.A.); (M.C.); (P.F.); (E.C.); (N.T.); (J.-M.V.-R.)
- Departament de Ciències Experimentals i de la Salut, School of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain;
- Correspondence:
| | - Esther Calero
- Bellvitge University Hospital, Institut Català de la Salut, 08921 Barcelona, Spain;
| | - Julio Duran
- Clinica Sant Antoni (Institut Medic i de Rehabilitació), 08038 Barcelona, Spain;
| | - Elena Navas
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain;
| | - Susana Alonso
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain; (S.A.); (N.A.); (M.C.); (P.F.); (E.C.); (N.T.); (J.-M.V.-R.)
| | - Nuria Argemí
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain; (S.A.); (N.A.); (M.C.); (P.F.); (E.C.); (N.T.); (J.-M.V.-R.)
| | - Marta Casademunt
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain; (S.A.); (N.A.); (M.C.); (P.F.); (E.C.); (N.T.); (J.-M.V.-R.)
| | - Patricia Furió
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain; (S.A.); (N.A.); (M.C.); (P.F.); (E.C.); (N.T.); (J.-M.V.-R.)
| | - Elena Casajuana
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain; (S.A.); (N.A.); (M.C.); (P.F.); (E.C.); (N.T.); (J.-M.V.-R.)
| | - Nuria Torralba
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain; (S.A.); (N.A.); (M.C.); (P.F.); (E.C.); (N.T.); (J.-M.V.-R.)
| | - Nuria Farre
- Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain;
| | - Rosa Abellana
- Departament de Fonaments Clínics-Bioestadística, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain;
| | - José-Maria Verdú-Rotellar
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, 08007 Barcelona, Spain; (S.A.); (N.A.); (M.C.); (P.F.); (E.C.); (N.T.); (J.-M.V.-R.)
- Departament de Ciències Experimentals i de la Salut, School of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08007 Barcelona, Spain;
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Bat-Erdene BI, Zheng H, Son SH, Lee JY. Deep learning-based prediction of heart failure rehospitalization during 6, 12, 24-month follow-ups in patients with acute myocardial infarction. Health Informatics J 2022; 28:14604582221101529. [PMID: 35587458 DOI: 10.1177/14604582221101529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure is a clinical syndrome that occurs when the heart is too weak or stiff and cannot pump enough blood that our body needs. It is one of the most expensive diseases due to frequent hospitalizations and emergency room visits. Reducing unnecessary rehospitalizations is also an important and challenging task that has the potential of saving healthcare costs, enabling discharge planning, and identifying patients at high risk. Therefore, this paper proposes a deep learning-based prediction model of heart failure rehospitalization during 6, 12, 24-month follow-ups after hospital discharge in patients with acute myocardial infarction (AMI). We used the Korea Acute Myocardial Infarction-National Institutes of Health (KAMIR-NIH) registry which included 13,104 patient records and 551 features. The proposed deep learning-based rehospitalization prediction model outperformed traditional machine learning algorithms such as logistic regression, support vector machine, AdaBoost, gradient boosting machine, and random forest. The performance of the proposed model was accuracy, the area under the curve, precision, recall, specificity, and F1 score of 99.37%, 99.90%, 96.86%, 98.61%, 99.49%, and 97.73%, respectively. This study showed the potential of a deep learning-based model for cardiology, which can be used for decision-making and medical diagnosis tool of heart failure rehospitalization in patients with AMI.
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Affiliation(s)
- Bat-Ireedui Bat-Erdene
- Department of Computer Science, 34933Chungbuk National University, Cheongju, South Korea
| | - Huilin Zheng
- Department of Computer Science, 34933Chungbuk National University, Cheongju, South Korea
| | - Sang Hyeok Son
- Department of Computer Science, 34933Chungbuk National University, Cheongju, South Korea
| | - Jong Yun Lee
- Department of Computer Science, 34933Chungbuk National University, Cheongju, South Korea
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Gerharz A, Ruff C, Wirbka L, Stoll F, Haefeli WE, Groll A, Meid AD. Predicting Hospital Readmissions from Health Insurance Claims Data: A Modeling Study Targeting Potentially Inappropriate Prescribing. Methods Inf Med 2022; 61:55-60. [PMID: 35144291 DOI: 10.1055/s-0042-1742671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Numerous prediction models for readmissions are developed from hospital data whose predictor variables are based on specific data fields that are often not transferable to other settings. In contrast, routine data from statutory health insurances (in Germany) are highly standardized, ubiquitously available, and would thus allow for automatic identification of readmission risks. OBJECTIVES To develop and internally validate prediction models for readmissions based on potentially inappropriate prescribing (PIP) in six diseases from routine data. METHODS In a large database of German statutory health insurance claims, we detected disease-specific readmissions after index admissions for acute myocardial infarction (AMI), heart failure (HF), a composite of stroke, transient ischemic attack or atrial fibrillation (S/AF), chronic obstructive pulmonary disease (COPD), type-2 diabetes mellitus (DM), and osteoporosis (OS). PIP at the index admission was determined by the STOPP/START criteria (Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert doctors to the Right Treatment) which were candidate variables in regularized prediction models for specific readmission within 90 days. The risks from disease-specific models were combined ("stacked") to predict all-cause readmission within 90 days. Validation performance was measured by the c-statistics. RESULTS While the prevalence of START criteria was higher than for STOPP criteria, more single STOPP criteria were selected into models for specific readmissions. Performance in validation samples was the highest for DM (c-statistics: 0.68 [95% confidence interval (CI): 0.66-0.70]), followed by COPD (c-statistics: 0.65 [95% CI: 0.64-0.67]), S/AF (c-statistics: 0.65 [95% CI: 0.63-0.66]), HF (c-statistics: 0.61 [95% CI: 0.60-0.62]), AMI (c-statistics: 0.58 [95% CI: 0.56-0.60]), and OS (c-statistics: 0.51 [95% CI: 0.47-0.56]). Integrating risks from disease-specific models to a combined model for all-cause readmission yielded a c-statistics of 0.63 [95% CI: 0.63-0.64]. CONCLUSION PIP successfully predicted readmissions for most diseases, opening the possibility for interventions to improve these modifiable risk factors. Machine-learning methods appear promising for future modeling of PIP predictors in complex older patients with many underlying diseases.
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Affiliation(s)
- Alexander Gerharz
- Department of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Carmen Ruff
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Lucas Wirbka
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Felicitas Stoll
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Andreas Groll
- Department of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
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11
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Van Grootven B, Jepma P, Rijpkema C, Verweij L, Leeflang M, Daams J, Deschodt M, Milisen K, Flamaing J, Buurman B. Prediction models for hospital readmissions in patients with heart disease: a systematic review and meta-analysis. BMJ Open 2021; 11:e047576. [PMID: 34404703 PMCID: PMC8372817 DOI: 10.1136/bmjopen-2020-047576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/30/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To describe the discrimination and calibration of clinical prediction models, identify characteristics that contribute to better predictions and investigate predictors that are associated with unplanned hospital readmissions. DESIGN Systematic review and meta-analysis. DATA SOURCE Medline, EMBASE, ICTPR (for study protocols) and Web of Science (for conference proceedings) were searched up to 25 August 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were eligible if they reported on (1) hospitalised adult patients with acute heart disease; (2) a clinical presentation of prediction models with c-statistic; (3) unplanned hospital readmission within 6 months. PRIMARY AND SECONDARY OUTCOME MEASURES Model discrimination for unplanned hospital readmission within 6 months measured using concordance (c) statistics and model calibration. Meta-regression and subgroup analyses were performed to investigate predefined sources of heterogeneity. Outcome measures from models reported in multiple independent cohorts and similarly defined risk predictors were pooled. RESULTS Sixty studies describing 81 models were included: 43 models were newly developed, and 38 were externally validated. Included populations were mainly patients with heart failure (HF) (n=29). The average age ranged between 56.5 and 84 years. The incidence of readmission ranged from 3% to 43%. Risk of bias (RoB) was high in almost all studies. The c-statistic was <0.7 in 72 models, between 0.7 and 0.8 in 16 models and >0.8 in 5 models. The study population, data source and number of predictors were significant moderators for the discrimination. Calibration was reported for 27 models. Only the GRACE (Global Registration of Acute Coronary Events) score had adequate discrimination in independent cohorts (0.78, 95% CI 0.63 to 0.86). Eighteen predictors were pooled. CONCLUSION Some promising models require updating and validation before use in clinical practice. The lack of independent validation studies, high RoB and low consistency in measured predictors limit their applicability. PROSPERO REGISTRATION NUMBER CRD42020159839.
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Affiliation(s)
- Bastiaan Van Grootven
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Research Foundation Flanders, Brussel, Belgium
| | - Patricia Jepma
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Corinne Rijpkema
- Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, Netherlands
| | - Lotte Verweij
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Mariska Leeflang
- Faculty of Science, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Joost Daams
- Medical Library, Amsterdam UMC Location AMC, Amsterdam, North Holland, Netherlands
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Public Health, University of Basel, Basel, Switzerland
| | - Koen Milisen
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, University Hospitals Leuven, Leuven, Belgium
- Department of Geriatric Medicine, KU Leuven - University of Leuven, Leuven, Belgium
| | - Bianca Buurman
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Faculty of Science, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
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12
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Gonçalves DM, Henriques R, Costa RS. Predicting Postoperative Complications in Cancer Patients: A Survey Bridging Classical and Machine Learning Contributions to Postsurgical Risk Analysis. Cancers (Basel) 2021; 13:cancers13133217. [PMID: 34203189 PMCID: PMC8269422 DOI: 10.3390/cancers13133217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/04/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Structured survey on the predictive analysis of postoperative complications in oncology, bridging classic risk scores with machine learning advances, and further establishing principles to guide the design of cohort studies and the predictive modeling of postsurgical risks. Abstract Postoperative complications can impose a significant burden, increasing morbidity, mortality, and the in-hospital length of stay. Today, the number of studies available on the prognostication of postsurgical complications in cancer patients is growing and has already created a considerable set of dispersed contributions. This work provides a comprehensive survey on postoperative risk analysis, integrating principles from classic risk scores and machine-learning approaches within a coherent frame. A qualitative comparison is offered, taking into consideration the available cohort data and the targeted postsurgical outcomes of morbidity (such as the occurrence, nature or severity of postsurgical complications and hospitalization needs) and mortality. This work further establishes a taxonomy to assess the adequacy of cohort studies and guide the development and assessment of new learning approaches for the study and prediction of postoperative complications.
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Affiliation(s)
- Daniel M. Gonçalves
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal; (D.M.G.); (R.S.C.)
- INESC-ID, Lisboa Portugal and Instituto Superior Técnico, Universidade de Lisboa, R. Alves Redol 9, 1000-029 Lisboa, Portugal
| | - Rui Henriques
- INESC-ID, Lisboa Portugal and Instituto Superior Técnico, Universidade de Lisboa, R. Alves Redol 9, 1000-029 Lisboa, Portugal
- Correspondence: ; Tel.: +351-21-310-0300
| | - Rafael S. Costa
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal; (D.M.G.); (R.S.C.)
- LAQV-REQUIMTE, NOVA School of Science and Technology, Campus Caparica, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
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Kang Y, Sheng X, Stehlik J, Mooney K. Identifying Targets to Improve Heart Failure Outcomes for Patients Receiving Home Healthcare Services: The Relationship of Functional Status and Pain. Home Healthc Now 2020; 38:24-30. [PMID: 31895894 PMCID: PMC7678889 DOI: 10.1097/nhh.0000000000000830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Heart failure (HF) is one of the leading causes of rehospitalization in the United States. Due to the complex nature of HF, the provision of Medicare-certified home healthcare services has increased. Medicare-certified home healthcare agencies measure and report patients' outcomes such as functional status, activities of daily living (ADL), and instrumental activities of daily living to the Centers for Medicare and Medicaid Services. These metrics are assessed using the Outcome and Assessment Information Set (OASIS). As a large data set, OASIS has been used to advance care quality in multiple ways including identifying risk factors for negative patient outcomes. However, there is a lack of OASIS analyses to assess the relationship between functional status and the role of other factors, such as pain, in impeding recovery after hospitalization among HF patients. Therefore, the purpose of this study is to identify the relationship between functional status and pain using the OASIS database. Among 489 HF patients admitted to home healthcare, 83% were White, 57% were female, and the median age was 80. Patients who reported daily but not constant activity-interfering pain at discharge demonstrated the least improvement in functional performance as measured by ADLs, whereas patients without activity-interfering pain demonstrated the greatest improvement in ADL performance (p value = 0.0284). Tracking individual patient ADL scores, particularly the frequency of activity-interfering pain, could be a key indicator for clinical focus for patients with HF in the home healthcare setting.
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Affiliation(s)
- Youjeong Kang
- Youjeong Kang, PhD, MPH, CCRN, is an Assistant Professor, Health Systems & Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah. Xiaoming Sheng, PhD, is a Research Professor, Health Systems & Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah. Josef Stehlik, MD, is a Professor, University of Utah School of Medicine, Salt Lake City, Utah. Kathi Mooney, PhD, RN, FAAN, is a Distinguished Professor, University of Utah College of Nursing, Salt Lake City, Utah
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14
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Wang Y, Yang MX, Tu Q, Tao LY, Liu G, An H, Zhang H, Jin JL, Fan JS, Du YF, Zheng JG, Ren JY. Impact of Prior Ischemic Stroke on Outcomes in Patients With Heart Failure - A Propensity-Matched Study. Circ J 2020; 84:1797-1806. [PMID: 32893260 DOI: 10.1253/circj.cj-20-0210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Whether ischemic stroke per se, rather than older age or additional comorbidities, accounts for the adverse prognosis of heart failure (HF) is uncertain. The present study examineed the intrinsic association of ischemic stroke with outcomes in a propensity-matched cohort.Methods and Results:Of 1,351 patients hospitalized with HF, 388 (28.7%) had prior ischemic stroke. Using propensity score for prior ischemic stroke, estimated for each patient, a matched cohort of 379 pairs of HF patients with and without prior ischemic stroke, balanced on 32 baseline characteristics was assembled. At 30 days, prior ischemic stroke was associated with significantly higher risks of the combined endpoint of all-cause death or readmission (hazard ratio [HR]: 1.91; 95% confidence interval [CI]: 1.38 to 2.65; P<0.001), all-cause death (HR: 2.08; 95% CI: 1.28 to 3.38; P=0.003), all-cause readmission (HR: 2.67; 95% CI: 1.78 to 4.01; P<0.001), and HF readmission (HR: 2.11; 95% CI: 1.19 to 3.72; P=0.010). Prior ischemic stroke was associated with a significantly higher risk of all 4 outcomes at both 6 months and 1 year. CONCLUSIONS Prior ischemic stroke was a potent and persistent risk predictor of death and readmission among patients with HF after accounting for clinical characteristics.
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Affiliation(s)
- Yu Wang
- Department of Cardiology, China-Japan Friendship Hospital
| | - Meng-Xi Yang
- Department of Cardiology, China-Japan Friendship Hospital
| | - Qiang Tu
- State Key Laboratory for Molecular and Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences.,University of Chinese Academy of Sciences
| | - Li-Yuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital
| | - Gang Liu
- Department of Cardiovascular Surgery, Peking University People's Hospital
| | - Hui An
- Department of Cardiology, Hebei General Hospital
| | - Hu Zhang
- Department of Cardiology, China-Japan Friendship Hospital
| | - Jiang-Li Jin
- Department of Neurology, China-Japan Friendship Hospital
| | - Jia-Sai Fan
- Department of Cardiology, China-Japan Friendship Hospital
| | - Yi-Fei Du
- Department of Cardiology, China-Japan Friendship Hospital
| | - Jin-Gang Zheng
- Department of Cardiology, China-Japan Friendship Hospital
| | - Jing-Yi Ren
- Department of Cardiology, China-Japan Friendship Hospital.,Vascular Health Research Center of Peking University Health Science Center
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15
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Yap J. Risk stratification in heart failure: Existing challenges and potential promise. Int J Cardiol 2020; 313:97-98. [DOI: 10.1016/j.ijcard.2020.04.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 11/27/2022]
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16
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Yang M, Tao L, An H, Liu G, Tu Q, Zhang H, Qin L, Xiao Z, Wang Y, Fan J, Feng D, Liang Y, Ren J. A novel nomogram to predict all-cause readmission or death risk in Chinese elderly patients with heart failure. ESC Heart Fail 2020; 7:1015-1024. [PMID: 32319228 PMCID: PMC7261546 DOI: 10.1002/ehf2.12703] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/21/2020] [Accepted: 03/18/2020] [Indexed: 12/12/2022] Open
Abstract
Aims Elderly patients with heart failure (HF) are associated with frequent all‐cause readmission or death. The present study sought to develop an accurate and easy‐to‐use model to predict all‐cause readmission or death risk in Chinese elderly patients with HF. Methods and results This was a prospective cohort study in patients with HF aged 65 or older. Demographic, co‐morbidity, laboratory, and medication data were collected. A Cox regression model was used to identify factors for the prediction of readmission or death at 30 days and 1 year. A nomogram was developed with bootstrap validation. Of the included 854 patients, the cumulative all‐cause readmission and mortality rates were 10.5% and 11.6% at 30 days and 34.9% and 19.7% at 1 year, respectively. The independent risk factors associated with both 30 day and 1 year readmission or death were older age, stroke, diastolic blood pressure < 60 mmHg, body mass index ≤ 18.5 kg/m2, lower estimated glomerular filtration rate, and BNP > 400 pg/mL (all P < 0.05). Anaemia, abnormal neutrophils, and admission without angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers were the specific independent risk factors of 30 day all‐cause readmission or death (all P < 0.05), whereas serum sodium ≤ 140 mmol/L and admission without beta‐blockers were the specific independent risk factors of 1 year all‐cause readmission or death (all P < 0.05). The C‐index of the 30 day and 1 year diagnosis prediction model was 0.778 [95% confidence interval (CI) 0.693–0.862] and 0.738 (95% CI 0.640–0.836), respectively. Conclusions We developed accurate and easy‐to‐use nomograms to predict all‐cause readmission or death in Chinese elderly patients with HF. The nomograms will assist in reducing the all‐cause readmission and mortality rates.
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Affiliation(s)
- Mengxi Yang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Hui An
- Department of Cardiology, Hebei General Hospital, Hebei, China
| | - Gang Liu
- Department of Cardiovascular Surgery, Peking University People's Hospital, Beijing, China
| | - Qiang Tu
- State Key Laboratory for Molecular and Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Hu Zhang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Li Qin
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing, China
| | - Zhu Xiao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yu Wang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jiaxai Fan
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Dongping Feng
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Yan Liang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jingyi Ren
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, China
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Masip J, Formiga F, Comín-Colet J, Corbella X. Short term prognosis of heart failure after first hospital admission. Med Clin (Barc) 2020; 154:37-44. [PMID: 31153608 DOI: 10.1016/j.medcli.2019.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Death and unexpected readmission are frequent among heart failure patients. We aimed to assess 30-day readmission and mortality rate as well as to identify predictive factors for patients discharged from a first HF related hospital admission. METHODS AND RESULTS Retrospective, single-center, cohort study, using administrative data from a tertiary care hospital in Barcelona, Spain. Patients discharged alive from a first HF related admission from 2010 to 2014 were assessed for 30-day death, readmission and adverse outcome rate. A Linear Logistic Regression Model was fitted for each outcome. The set accounted for 3642 patients; 50.1% female and 49.9% male. Mean age was 76 years (SD=12). 30-Days rates were 9.2% for readmission, 5.6% for death and 13.8% for adverse outcome. Admission to an ED within 30 days was strongly linked to readmission (OR=6.97), death (OR=2.31) and adverse outcome (OR=8.55), as well as chronic kidney disease (OR=1.44/1.61/2.86 respectively). Discharge to a Long Stay Care (LSC) facility was linked to lower readmission and adverse event rates (OR=.57 and OR=.15). CONCLUSION Pre and post-index discharge use of health care resources is related to adverse outcome rates. Our findings point out the potential benefit for a more tailored approach in the management of HF patients.
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Affiliation(s)
- Joan Masip
- Medical Coding Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comín-Colet
- Heart Failure Program, Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Cardiovascular Diseases Research Group, Research Programme in Inflammatory, Chronic and Degenerative Diseases, IDIBELL (Bellvitge Biomedical Research Institute), Hospitalet de Llobregat, Barcelona, Spain; Heart Diseases Biomedical Research Group, Research Programme in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona Biomedical Research Park, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Evaluating risk prediction models for adults with heart failure: A systematic literature review. PLoS One 2020; 15:e0224135. [PMID: 31940350 PMCID: PMC6961879 DOI: 10.1371/journal.pone.0224135] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/24/2019] [Indexed: 12/25/2022] Open
Abstract
Background The ability to predict risk allows healthcare providers to propose which patients might benefit most from certain therapies, and is relevant to payers’ demands to justify clinical and economic value. To understand the robustness of risk prediction models for heart failure (HF), we conducted a systematic literature review to (1) identify HF risk-prediction models, (2) assess statistical approach and extent of validation, (3) identify common variables, and (4) assess risk of bias (ROB). Methods Literature databases were searched from March 2013 to May 2018 to identify risk prediction models conducted in an out-of-hospital setting in adults with HF. Distinct risk prediction variables were ranked according to outcomes assessed and incorporation into the studies. ROB was assessed using Prediction model Risk Of Bias ASsessment Tool (PROBAST). Results Of 4720 non-duplicated citations, 40 risk-prediction publications were deemed relevant. Within the 40 publications, 58 models assessed 55 (co)primary outcomes, including all-cause mortality (n = 17), cardiovascular death (n = 9), HF hospitalizations (n = 15), and composite endpoints (n = 14). Few publications reported detail on handling missing data (n = 11; 28%). The discriminatory ability for predicting all-cause mortality, cardiovascular death, and composite endpoints was generally better than for HF hospitalization. 105 distinct predictor variables were identified. Predictors included in >5 publications were: N-terminal prohormone brain-natriuretic peptide, creatinine, blood urea nitrogen, systolic blood pressure, sodium, NYHA class, left ventricular ejection fraction, heart rate, and characteristics including male sex, diabetes, age, and BMI. Only 11/58 (19%) models had overall low ROB, based on our application of PROBAST. In total, 26/58 (45%) models discussed internal validation, and 14/58 (24%) external validation. Conclusions The majority of the 58 identified risk-prediction models for HF present particular concerns according to ROB assessment, mainly due to lack of validation and calibration. The potential utility of novel approaches such as machine learning tools is yet to be determined. Registration number The SLR was registered in Prospero (ID: CRD42018100709).
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Usefulness of systolic blood pressure combined with heart rate measured on admission to identify 1-year all-cause mortality risk in elderly patients firstly hospitalized due to acute heart failure. Aging Clin Exp Res 2020; 32:99-106. [PMID: 30790241 DOI: 10.1007/s40520-019-01153-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Systolic blood pressure (SBP) and heart rate (HR) are well-known prognostic factors in heart failure (HF). AIMS Our objective was to assess the value of the combination of admission SBP and HR to estimate 1-year mortality risks in elderly patients admitted due to a first episode of acute HF (AHF). METHODS During a 36-month period, we retrospectively reviewed 901 consecutive patients aged ≥ 75 admitted because of a first episode of AHF. According to admission SBP-HR combinations, three groups were defined: "low-risk" (HR < 70 bpm and SBP ≥ 140 mmHg), "moderate-risk" (HR < 70 bpm and SBP < 140 mmHg or HR ≥ 70 bmp and SBP ≥ 120 mmHg), and "high-risk" (HR ≥ 70 bpm and SBP < 120 mmHg). We analyzed all-cause mortality using Cox mortality analysis. RESULTS One-year mortality ranged from 16.5% for patients in the low-risk group to 50% for those in the high-risk group (p < 0.0001). Multivariate Cox regression for 1-year mortality showed hazard risk (HzR) ratios, compared to that (HzR 1) of the low-risk reference group, of 1.759 (95% CI 1.035-2.988, p = 0.037) for moderate-risk, and 3.171 (95% CI 1.799-5.589, p = 0.0001) for high-risk group. Prior use of a high number of chronic therapies (HzR 1.045), lower admission diastolic BP (HzR 0.986) and higher admission serum potassium values (HzR 1.534) were also significantly associated with mortality. CONCLUSION In elderly population firstly hospitalized due to AHF, the simple combined admission measurement of SBP and HR predicts higher risk for 1-year all-cause mortality.
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Delgado JF, Ferrero Gregori A, Fernández LM, Claret RB, Sepúlveda AG, Fernández-Avilés F, González-Juanatey JR, García RV, Otero MR, Segovia Cubero J, Pascual Figal D, Crespo-Leiro MG, Alvarez-García J, Cinca J, Ynsaurriaga FA. Patient-Associated Predictors of 15- and 30-Day Readmission After Hospitalization for Acute Heart Failure. Curr Heart Fail Rep 2019; 16:304-314. [DOI: 10.1007/s11897-019-00442-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Park C, Otobo E, Ullman J, Rogers J, Fasihuddin F, Garg S, Kakkar S, Goldstein M, Chandrasekhar SV, Pinney S, Atreja A. Impact on Readmission Reduction Among Heart Failure Patients Using Digital Health Monitoring: Feasibility and Adoptability Study. JMIR Med Inform 2019; 7:e13353. [PMID: 31730039 PMCID: PMC6913758 DOI: 10.2196/13353] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/22/2019] [Accepted: 08/19/2019] [Indexed: 01/14/2023] Open
Abstract
Background Heart failure (HF) is a condition that affects approximately 6.2 million people in the United States and has a 5-year mortality rate of approximately 42%. With the prevalence expected to exceed 8 million cases by 2030, projections estimate that total annual HF costs will increase to nearly US $70 billion. Recently, the advent of remote monitoring technology has significantly broadened the scope of the physician’s reach in chronic disease management. Objective The goal of our program, named the Heart Health Program, was to examine the feasibility of using digital health monitoring in real-world home settings, ascertain patient adoption, and evaluate impact on 30-day readmission rate. Methods A digital medicine software platform developed at Mount Sinai Health System, called RxUniverse, was used to prescribe a digital care pathway including the HealthPROMISE digital therapeutic and iHealth mobile apps to patients’ personal smartphones. Vital sign data, including blood pressure (BP) and weight, were collected through an ambulatory remote monitoring system that comprised a mobile app and complementary consumer-grade Bluetooth-connected smart devices (BP cuff and digital scale) that send data to the provider care teams. Care teams were alerted via a Web-based dashboard of abnormal patient BP and weight change readings, and further action was taken at the clinicians’ discretion. We used statistical analyses to determine risk factors associated with 30-day all-cause readmission. Results Overall, the Heart Health Program included 58 patients admitted to the Mount Sinai Hospital for HF. The 30-day hospital readmission rate was 10% (6/58), compared with the national readmission rates of approximately 25% and the Mount Sinai Hospital’s average of approximately 23%. Single marital status (P=.06) and history of percutaneous coronary intervention (P=.08) were associated with readmission. Readmitted patients were also less likely to have been previously prescribed angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (P=.02). Notably, readmitted patients utilized the BP and weight monitors less than nonreadmitted patients, and patients aged younger than 70 years used the monitors more frequently on average than those aged over 70 years, though these trends did not reach statistical significance. The percentage of the 58 patients using the monitors at least once dropped from 83% (42/58) in the first week after discharge to 46% (23/58) in the fourth week. Conclusions Given the increasing burden of HF, there is a need for an effective and sustainable remote monitoring system for HF patients following hospital discharge. We identified clinical and social factors as well as remote monitoring usage trends that identify targetable patient populations that could benefit most from integration of daily remote monitoring. In addition, we demonstrated that interventions driven by real-time vital sign data may greatly aid in reducing hospital readmissions and costs while improving patient outcomes.
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Affiliation(s)
- Christopher Park
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emamuzo Otobo
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jennifer Ullman
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jason Rogers
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Farah Fasihuddin
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Shashank Garg
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sarthak Kakkar
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marni Goldstein
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Sean Pinney
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashish Atreja
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Torii Y, Kusunose K, Yamada H, Nishio S, Hirata Y, Amano R, Yamao M, Zheng R, Saijo Y, Yamada N, Ise T, Yamaguchi K, Yagi S, Soeki T, Wakatsuki T, Sata M. Updated Left Ventricular Diastolic Function Recommendations and Cardiovascular Events in Patients with Heart Failure Hospitalization. J Am Soc Echocardiogr 2019; 32:1286-1297.e2. [DOI: 10.1016/j.echo.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/27/2022]
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Formiga F, Moreno-Gonzalez R, Chivite D, Yun S, Franco J, Ariza-Solé A, Corbella X. Sex differences in 1-year mortality risks in older patients experiencing a first acute heart failure hospitalization. Geriatr Gerontol Int 2018; 19:184-188. [PMID: 30548748 DOI: 10.1111/ggi.13580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/15/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022]
Abstract
AIM To assess whether 1-year mortality in older patients experiencing a first admission for acute heart failure was related to sex, and to explore differential characteristics according to sex. METHODS We reviewed the medical records of 1132 patients aged >70 years of age admitted within a 3-year period because of a first episode of acute heart failure. We analyzed sex differences. Mortality was assessed using multivariate Cox analysis. RESULTS There were 648 (57.2%) women (mean age 82.1 years) and 484 men (mean age 80.1 years). There were some differences in risk factors: women more often had hypertension, and less frequently had coronary heart disease and comorbidities (women more often had dementia, and men more often had chronic obstructive pulmonary disease, chronic kidney disease and stroke). Women were treated more frequently with spironolactone. The 1-year all-cause mortality rate was 30.2% (30.7% women and 29.5% men). Multivariate Cox analysis identified an association between reduced heart failure (hazard ratio [HR] 0.35, 95% confidence interval [95% CI] 0.21-0.59), hemoglobin <10 g/dL (HR 1.99, 95% CI 1.16-3.40), systolic blood pressure (HR 0.98, 95% CI 0.97-0.99), previous diagnosis of dementia (HR 2.07, 95% CI 1.12-3.85), number of chronic therapies (HR 1.12, 95% CI 1.05-1.19) and 1-year mortality in women. In men, an association with mortality was found for low systolic blood pressure (HR 0.97, 95% CI 0.97-0.98) and higher potassium values (HR 1.42, 95% CI 1.01-2.00). CONCLUSIONS Among older patients hospitalized for the first acute heart failure episode, there is a slightly higher predominance of women. There are sex differences in risk factors and comorbidities. Although the mortality rate is similar, the factors associated with it according to sex are different. Geriatr Gerontol Int 2019; 19: 184-188.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael Moreno-Gonzalez
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - David Chivite
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jonathan Franco
- Internal Medicine Department, Hospital Universitari Quiron Dexeus Universitary Hospital, Barcelona, Spain
| | - Albert Ariza-Solé
- Cardiology Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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24
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Lim NK, Lee SE, Lee HY, Cho HJ, Choe WS, Kim H, Choi JO, Jeon ES, Kim MS, Kim JJ, Hwang KK, Chae SC, Baek SH, Kang SM, Choi DJ, Yoo BS, Kim KH, Cho MC, Oh BH, Park HY. Risk prediction for 30-day heart failure-specific readmission or death after discharge: Data from the Korean Acute Heart Failure (KorAHF) registry. J Cardiol 2018; 73:108-113. [PMID: 30360893 DOI: 10.1016/j.jjcc.2018.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/18/2018] [Accepted: 07/25/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Identifying patients with acute heart failure (HF) at high risk for readmission or death after hospital discharge will enable the optimization of treatment and management. The objective of this study was to develop a risk score for 30-day HF-specific readmission or death in Korea. METHODS We analyzed the data from the Korean Acute Heart Failure (KorAHF) registry to develop a risk score. The model was derived from a multiple logistic regression analysis using a stepwise variable selection method. We also proposed a point-based risk score to predict the risk of 30-day HF-specific readmission or death by simply summing the scores assigned to each risk variable. Model performance was assessed using an area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow goodness-of-fit test, the net reclassification improvement (NRI), and the integrated discrimination improvement (IDI) index to evaluate discrimination, calibration, and reclassification, respectively. RESULTS Data from 4566 patients aged ≥40 years were included in the analysis. Among them, 446 (9.8%) had 30-day HF-specific readmission or death. The final model included 12 independent variables (age, New York Heart Association functional class, clinical history of hypertension, HF admission, chronic obstructive pulmonary disease, etiology of cardiomyopathy, systolic blood pressure, left ventricular ejection fraction, serum sodium, brain natriuretic peptide, N-terminal prohormone of brain natriuretic peptide at discharge, and prescription of β-blockers and angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists at discharge). The point risk score showed moderate discrimination (AUC of 0.710; 95% confidence interval, 0.685-0.735) and good calibration (χ2=8.540, p=0.3826). CONCLUSIONS The risk score for the prediction of the risk of 30-day HF-specific readmission or death after hospital discharge was developed using 12 predictors. It can be utilized to guide appropriate interventions or care strategies for patients with HF.
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Affiliation(s)
- Nam-Kyoo Lim
- Division of Cardiovascular Diseases, Korea National Institute of Health, Cheongju, Republic of Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won-Seok Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hokon Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Oh Choi
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Min-Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Republic of Korea
| | - Sang Hong Baek
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok-Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Kye Hun Kim
- Department of Internal Medicine, Heart Research Center of Chonnam National University, Gwangju, Republic of Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Byung-Hee Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Young Park
- Division of Cardiovascular Diseases, Korea National Institute of Health, Cheongju, Republic of Korea.
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Lower admission blood pressure as an independent predictor of 1-year mortality in elderly patients experiencing a first hospitalization for acute heart failure. Hellenic J Cardiol 2018; 60:224-229. [PMID: 30130621 DOI: 10.1016/j.hjc.2018.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Systolic blood pressure (SBP) is an acknowledged prognostic factor in patients with heart failure (HF). Admission SBP should be a risk factor for 1-year mortality even in elderly patients experiencing a first admission for HF, and this risk may persist in the oldest subset of patients. DESIGN Methods: We reviewed the medical records of 1031 patients aged 70 years or older admitted within a 3-year period for a first episode of acute heart failure (AHF). The cohort was divided according to admission SBP values in quartiles. We analyzed all-cause mortality as a function of these admission SBP quartiles. RESULTS Mean age was 82.2 ± 6 years; their mean admission SBP was 138.6 ± 25 mmHg. A statistically significant association was present between mortality at 30 (p < 0.0001), 90 (p < 0.0001), and 365 days (p < 0.0001) after hospital discharge and lower admission SBP quartiles. One-year mortality ranged from 14.7% for patients within the upper SBP quartile to 41.4% for those in the lowest quartile. The multivariate analysis confirmed this association (HR: 0.884; 95% CI: 0.615-0.76; p = 0.0001), which remained significant when admission SBP was evaluated as a continuous variable (HR: 0.980; 95% CI: 0.975-0.985; p = 0.0001). The association between SBP and 1-year mortality remained when the sample was divided into old (70-82 years) and "oldest-old" (>82 years) patients. CONCLUSIONS Lower SBP at admission is an independent predictor of midterm postdischarge mortality for elderly patients experiencing a first admission for AHF.
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Lymphocyte-to-white blood cells ratio in older patients experiencing a first acute heart failure hospitalization. Eur Geriatr Med 2018; 9:365-370. [PMID: 34654238 DOI: 10.1007/s41999-018-0051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Low lymphocyte counts are related to poor health results in heart failure (HF) patients. We assess whether a low lymphocyte-to-white blood cells ratio (LWR) is related to 1-year mortality in older patients experiencing a first hospitalization for acute HF. METHODS We evaluated 859 patients > 75 years of age admitted within a 33-month period because of a first episode of acute HF. Patients were divided into four groups according to LWR quartiles. RESULTS Patients' mean age was 83.5 ± 5.5 years and their median LWR was 16.7%. After 1 year of follow-up 270 patients (31.43%) died. Mean LWR values were significatively lower in the group of patients who died (15.1 vs. 17.4%; p = 0.001). Mortality rates were significantly higher in the lower LWR quartile either at 1 month, 3 months, and 1 year after the index acute HF episode. The univariate logistic regression analysis identified the LWR (either as quartiles or continuous variable) to be independently associated with higher risk of 1-year post-discharge mortality. Multivariate analysis confirmed this association (HR for LWR as a quartiles variable 1.525; 95% CI 1.161-2.003 and for LWR as a continuous variable 1.145; 95% CI 1.069-1854) besides older age, a higher comorbidity and higher admission potassium. CONCLUSIONS As is the case in other HF scenarios, a simple routine admission laboratory test such as lymphocyte count can independently predict 1-year mortality for older patients hospitalized for first time due to acute HF.
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Formiga F, Moreno-Gonzalez R, Chivite D, Franco J, Montero A, Corbella X. High comorbidity, measured by the Charlson Comorbidity Index, associates with higher 1-year mortality risks in elderly patients experiencing a first acute heart failure hospitalization. Aging Clin Exp Res 2017; 30:927-933. [PMID: 29124524 DOI: 10.1007/s40520-017-0853-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Comorbidity is related to poor health results in chronic heart failure (HF). AIMS The purpose of the study was to assess whether a high Charlson Comorbidity Index score (CCI) relates to 1 year mortality after a first hospitalization for acute HF (AHF). METHODS We reviewed the medical records of 897 patients > 65 years of age admitted within a two-year period because of a first episode of AHF. We analyzed two groups: low (CCI ≤ 2) and high (CCI > 2) comorbidity. RESULTS Patients' mean CCI was 2.2 ± 1.7; 344 patients (38.35%) had a CCI > 2. 1-year all-cause mortality rate in the high comorbidity group was 32.6%, worse than that among low comorbidity group patients (23.7%, p = 0.002). Cox multivariate analysis identified a CCI > 2 as an independent risk factor for 1-year mortality (p = 0.002; HR: 1.525; CI 95% 1.161-2.003), along with older age, history of arterial hypertension, and higher admission heart rate and serum potassium values. Analyzing CCI as a continuous variable, the association remained is also significant (p = 0.0001; HR 1.145; CI 95% 1.069-1.854). CONCLUSIONS Higher global comorbidity (CCI > 2) at the time of a first hospitalization because of AHF is an independent predictor of mid-term post-discharge mortality among elderly HF patients.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Rafael Moreno-Gonzalez
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - David Chivite
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jonathan Franco
- Internal Medicine Service, Hospital Universitari Quiron Dexeus, Barcelona, Spain
| | - Abelardo Montero
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Department, Universitary Hospital Bellvitge-IDIBELL, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Hestia Chair in Integrated Health and Social Care, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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28
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Emdin M, Aimo A, Vergaro G, Passino C. Predicting readmissions after hospitalization for heart failure: Medical reasoning vs calculators. Int J Cardiol 2017; 236:348-349. [DOI: 10.1016/j.ijcard.2017.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
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