title: Prospective development and validation of a model to predict heart failure hospitalisation.
abstract: OBJECTIVE
  Acute heart failure syndrome (AHFS) is a major cause of hospitalisation and imparts a substantial burden on patients and healthcare systems. Tools to define risk of AHFS hospitalisation are lacking.
  
  
  METHODS
  A prospective cohort study (n=628) of patients with stable chronic heart failure (CHF) secondary to left ventricular systolic dysfunction was used to derive an AHFS prediction model which was then assessed in a prospectively recruited validation cohort (n=462).
  
  
  RESULTS
  Within the derivation cohort, 44 (7%) patients were hospitalised as a result of AHFS during 1 year of follow-up. Predictors of AHFS hospitalisation included furosemide equivalent dose, the presence of type 2 diabetes mellitus, AHFS hospitalisation within the previous year and pulmonary congestion on chest radiograph, all assessed at baseline. A multivariable model containing these four variables exhibited good calibration (Hosmer-Lemeshow p=0.38) and discrimination (C-statistic 0.77; 95% CI 0.71 to 0.84). Using a 2.5% risk cut-off for predicted AHFS, the model defined 38.5% of patients as low risk, with negative predictive value of 99.1%; this low risk cohort exhibited <1% excess all-cause mortality per annum when compared with contemporaneous actuarial data. Within the validation cohort, an identically applied model derived comparable performance parameters (C-statistic 0.81 (95% CI 0.74 to 0.87), Hosmer-Lemeshow p=0.15, negative predictive value 100%).
  
  
  CONCLUSIONS
  A prospectively derived and validated model using simply obtained clinical data can identify patients with CHF at low risk of hospitalisation due to AHFS in the year following assessment. This may guide the design of future strategies allocating resources to the management of CHF.
authors.affiliation: Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Cubbon
authors.affiliation: Centre of Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
authors.forename: A
authors.initials: A
authors.lastname: Woolston
authors.affiliation: Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
authors.forename: B
authors.initials: B
authors.lastname: Adams
authors.affiliation: Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK Centre of Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Gale
authors.affiliation: Centre of Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
authors.forename: M S
authors.initials: MS
authors.lastname: Gilthorpe
authors.affiliation: Centre of Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
authors.forename: P D
authors.initials: PD
authors.lastname: Baxter
authors.affiliation: Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
authors.forename: L C
authors.initials: LC
authors.lastname: Kearney
authors.affiliation: Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
authors.forename: B
authors.initials: B
authors.lastname: Mercer
authors.affiliation: Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
authors.forename: A
authors.initials: A
authors.lastname: Rajwani
authors.affiliation: Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
authors.forename: P D
authors.initials: PD
authors.lastname: Batin
authors.affiliation: Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
authors.forename: M
authors.initials: M
authors.lastname: Kahn
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Sapsford
authors.affiliation: Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
authors.forename: K K
authors.initials: KK
authors.lastname: Witte
authors.affiliation: Leeds Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK.
authors.forename: M T
authors.initials: MT
authors.lastname: Kearney
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004739:England; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors