title: Predicting risk of hospitalization or death among patients with heart failure in the veterans health administration.
abstract: Patients with heart failure (HF) are at high risk of hospitalization or death. The objective of this study was to develop prediction models to identify patients with HF at highest risk for hospitalization or death. Using clinical and administrative databases, we identified 198,460 patients who received care from the Veterans Health Administration and had ≥1 primary or secondary diagnosis of HF that occurred within 1 year before June 1, 2009. We then tracked their outcomes of hospitalization and death during the subsequent 30 days and 1 year. Predictor variables chosen from 6 clinically relevant categories of sociodemographics, medical conditions, vital signs, use of health services, laboratory tests, and medications were used in multinomial regression models to predict outcomes of hospitalization and death. In patients who were in the ≥95th predicted risk percentile, observed event rates of hospitalization or death within 30 days and 1 year were 27% and 80% respectively, compared to population averages of 5% and 31%, respectively. The c-statistics for the 30-day outcomes were 0.82, 0.80, and 0.80 for hospitalization, death, and hospitalization or death, respectively, and 0.82, 0.76, and 0.77, respectively, for 1-year outcomes. In conclusion, prediction models using electronic health records can accurately identify patients who are at highest risk for hospitalization or death. This information can be used to assist care managers in selecting patients for interventions to decrease their risk of hospitalization or death.
authors: Health Service and Research Development, Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington, USA.
authors: Li
authors: L
authors: Wang
authors: Brian
authors: B
authors: Porter
authors: Charles
authors: C
authors: Maynard
authors: Christopher
authors: C
authors: Bryson
authors: Haili
authors: H
authors: Sun
authors: Elliott
authors: E
authors: Lowy
authors: Mary
authors: M
authors: McDonell
authors: Kathleen
authors: K
authors: Frisbee
authors: Christopher
authors: C
authors: Nielson
authors: Stephan D
authors: SD
authors: Fihn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs