Nam-Kyoo Lim1, Sang Eun Lee2, Hae-Young Lee3, Hyun-Jai Cho3, Won-Seok Choe3, Hokon Kim3, Jin Oh Choi4, Eun-Seok Jeon4, Min-Seok Kim2, Jae-Joong Kim2, Kyung-Kuk Hwang5, Shung Chull Chae6, Sang Hong Baek7, Seok-Min Kang8, Dong-Ju Choi9, Byung-Su Yoo10, Kye Hun Kim11, Myeong-Chan Cho5, Byung-Hee Oh3, Hyun-Young Park12. 1. Division of Cardiovascular Diseases, Korea National Institute of Health, Cheongju, Republic of Korea. 2. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 3. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. 4. Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea. 5. Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea. 6. Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Republic of Korea. 7. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 8. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. 9. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 10. Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. 11. Department of Internal Medicine, Heart Research Center of Chonnam National University, Gwangju, Republic of Korea. 12. Division of Cardiovascular Diseases, Korea National Institute of Health, Cheongju, Republic of Korea. Electronic address: hypark65@korea.kr.
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.
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.
Authors: Sebastian König; Vincent Pellissier; Johannes Leiner; Sven Hohenstein; Laura Ueberham; Andreas Meier-Hellmann; Ralf Kuhlen; Gerhard Hindricks; Andreas Bollmann Journal: Clin Cardiol Date: 2021-12-23 Impact factor: 2.882