title: Prediction of 30-day heart failure-specific readmission risk by echocardiographic parameters.
abstract: It is unknown whether echocardiographic morphologic and hemodynamic parameters have incremental value in predicting 30-day heart failure (HF)-specific readmission risk among patients admitted with HF. We performed a prospective cohort study of adult patients entering a transitional care program after HF hospitalization to assess the role of echocardiographic parameters in predicting 30-day HF-specific readmission risk. Patients were followed for at least 30 days postdischarge, and readmission outcomes were ascertained prospectively. A previously validated 30-day HF readmission score (Yale Center for Outcome Research and Evaluation [CORE]) was calculated using 20 clinical and pathology parameters. Atrial and ventricular morphologic and hemodynamic variables were obtained from the index hospitalization echocardiogram. A Cox proportional hazards model was used to identify variables associated with 30-day HF specific readmission risk. Among 283 patients (mean age 72 ± 14 years, 57% men, 54% ischemic HF, ejection fraction 35% ± 17%) who underwent echocardiography during index admission there were 46 HF specific readmissions. After risk adjustment, elevated echocardiographic right atrial pressure (RAP; hazard ratio [HR] 3.70, 95% confidence interval [CI] 1.82 to 7.52, p <0.001), left ventricular filling pressures (HR 7.46, 95% CI 2.31 to 24.14, p = 0.001), and weight change during admission (HR 0.93, 95% CI 0.87 to 0.99, p = 0.02) were independently associated with 30-day HF-specific readmission risk. However, only elevated RAP and left ventricular filling pressure added incremental prognostic value to the Yale-CORE HF readmission score. An E/e' threshold of 23 identified a subgroup at highest risk of readmission and provided a net 29% reclassification improvement over the Yale-CORE HF readmission score (p = 0.005).
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio; Department of Cardiology, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Paaladinesh
authors.initials: P
authors.lastname: Thavendiranathan
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Teerapat
authors.initials: T
authors.lastname: Yingchoncharoen
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Andrew
authors.initials: A
authors.lastname: Grant
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio.
authors.forename: Sinziana
authors.initials: S
authors.lastname: Seicean
authors.affiliation: Center for Post-Acute Care, Cleveland Clinic, Cleveland, Ohio; Visiting Nurses Association Health Group, Red Bank, New Jersey.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Landers
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio; Center for Post-Acute Care, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eiran Z
authors.initials: EZ
authors.lastname: Gorodeski
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland, Ohio; Menzies Research Institute Tasmania, 17 Liverpool Street, Hobart, Australia. Electronic address: tom.marwick@utas.edu.au.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
mesh_terms: D000368:Aged; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D009820:Ohio / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*