Prediction of rehospitalization and death in severe heart failure by physicians and nurses of the ESCAPE trial.
BACKGROUND
The predictive accuracy of physician investigators and nurse coordinators in estimating the risk of rehospitalization and death was determined for 373 hospitalized patients with severe advanced heart failure enrolled in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial.


RESULTS
Estimates were made at discharge, and patients were followed for 6 months after hospitalization. A statistical prognostic model was developed from clinical and laboratory data for the end points of rehospitalization and death. Both nurse and physician predictions of death were generally associated with the observed deaths (c-indices of 0.675 and 0.611), although the nurses' prediction was significantly better (chi-square = 4.75, P = .029). The prediction ability of the prognostic model was similar to the physicians' model (c-index = 0.603). The predictions of rehospitalization were much weaker for nurse, physician and prognostic models.


CONCLUSIONS
Nurses' estimations of survival in discharged, advanced-stage heart failure patients were superior to either physicians' or model-based predictions. Not nurses, physicians, or the prognostic model provided useful predictions for rehospitalizations, but this may have resulted from the fact that the rehospitalization estimates did not include the death risk.
Yamokoski
Laura M
LM
The Ohio State University Medical Center, Columbus, Ohio 43210, USA.
Hasselblad
Vic
V
Moser
Debra K
DK
Binanay
Cynthia
C
Conway
Ginger A
GA
Glotzer
Jana M
JM
Hartman
Karen A
KA
Stevenson
Lynne W
LW
Leier
Carl V
CV
D000328:Adult; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009726:Nurses; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010820:Physicians; D011379:Prognosis; D012306:Risk; D016019:Survival Analysis