title: Using the LACE index to predict hospital readmissions in congestive heart failure patients.
abstract: BACKGROUND
  The LACE index has been used to predict the risk of unplanned readmission within 30 days after hospital discharge in both medical and surgical patients. The aim of this study is to validate the accuracy of using the LACE index in CHF patients.
  
  
  METHODS
  This was a retrospective study. The LACE index score was calculated on each patient who was admitted to hospital due to an acute CHF exacerbation. Operational and clinical variables were collected from patients including basic clinical characteristics, length of hospitalization, comorbidities, number of previous ED visits in the past 6 months before the index admission, and the number of post discharge ED revisits at 30, 60, and 90 days. All variables were analyzed by multivariate logistic regression to determine the association between clinical variables and the hospital unplanned readmissions. C-statistic was used to discriminate those patients with high risk of readmissions.
  
  
  RESULTS
  Of the 253 patients included in the study, 24.50% (62/253) experienced unplanned readmission to hospital within 30 days after discharge. The LACE index was slightly higher in patients readmitted versus patients not readmitted (12.17 ± 2.22 versus 11.80 ± 1.92, p = 0.199). Adjusted odds ratios based on logistic regression of all clinical variables showed only the number of previous ED visits (OR 1.79, 95% CI 1.30-2.47, p < 0.001), history of myocardial infarction (OR 2.51, 95% CI 1.02-6.21, p = 0.045), and history of peripheral vascular disease (OR 10.75, 95% CI 1.52-75.73, p = 0.017) increased the risk of unplanned readmission within 30 days of hospital discharge. However, patients with high LACE scores (≥10) had a significantly higher rate of ED revisits (15.04% vs 0%) within 30 days from the index discharge than those with low LACE scores (p = 0.030).
  
  
  CONCLUSIONS
  The LACE index may not accurately predict unplanned readmissions within 30 days from hospital discharge in CHF patients. The LACE high risk index may have utility as a screening tool to predict high risk ED revisits after hospital discharge.
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Service, John Peter Smith Health Network, 1500 S, Main St, 76104 Fort Worth, TX, USA. hwang01@jpshealth.org.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Richard D
authors.initials: RD
authors.lastname: Robinson
authors.forename: Carlos
authors.initials: C
authors.lastname: Johnson
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Zenarosa
authors.forename: Rani D
authors.initials: RD
authors.lastname: Jayswal
authors.forename: Joshua
authors.initials: J
authors.lastname: Keithley
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Delaney
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D010359:Patient Readmission; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
references.citation: Clin Res Cardiol. 2006;95 Suppl 3:III29-35
references.pmid: 16598601
references.citation: Arch Intern Med. 1999 Feb 8;159(3):257-61
references.pmid: 9989537
references.citation: CMAJ. 2010 Apr 6;182(6):551-7
references.pmid: 20194559
references.citation: BMC Health Serv Res. 2013 Sep 29;13:366
references.pmid: 24074454
references.citation: J Gen Intern Med. 1998 Sep;13(9):614-20
references.pmid: 9754517
references.citation: Isr Med Assoc J. 2012 Dec;14(12):752-6
references.pmid: 23393714
references.citation: Am J Med. 2000 Oct 1;109(5):386-90
references.pmid: 11020395
references.citation: Lancet. 1999 Sep 25;354(9184):1077-83
references.pmid: 10509499
references.citation: Gynecol Oncol. 2013 Sep;130(3):407-10
references.pmid: 23747329
references.citation: Open Med. 2012 Jul 19;6(3):e80-90
references.pmid: 23696773
references.citation: Ann Emerg Med. 2001 Jun;37(6):561-7
references.pmid: 11385324
references.citation: J Vasc Surg. 2013 Apr;57(4):955-62
references.pmid: 23332242
references.citation: Circ Heart Fail. 2013 Jan;6(1):40-6
references.pmid: 23230305
references.citation: J Formos Med Assoc. 2002 Nov;101(11):779-85
references.pmid: 12517058
references.citation: Can J Cardiol. 2009 Jun;25(6):e173-8
references.pmid: 19536386
references.citation: Medicine (Baltimore). 2008 Sep;87(5):294-300
references.pmid: 18794712
references.citation: Aust Health Rev. 2013 Jun;37(3):362-8
references.pmid: 23701906
references.citation: Ann Intern Med. 1995 Mar 15;122(6):415-21
references.pmid: 7856989
references.citation: Heart. 2013 Dec;99(23):1717-26
references.pmid: 23680885
references.citation: CMAJ. 2013 Oct 1;185(14):E681-9
references.pmid: 23959284
references.citation: Am Heart J. 2012 Sep;164(3):365-72
references.pmid: 22980303
references.citation: Arch Intern Med. 2004 Nov 22;164(21):2315-20
references.pmid: 15557409
references.citation: Open Med. 2011;5(2):e104-11
references.pmid: 21915234
references.citation: Cancer Epidemiol Biomarkers Prev. 2012 Jul;21(7):1115-25
references.pmid: 22573797
references.citation: J Vasc Interv Neurol. 2013 Dec;6(2):47-51
references.pmid: 24358417
references.citation: BMJ. 2013 Nov 20;347:f6571
references.pmid: 24259033
references.citation: Clin Cardiol. 2009 Jan;32(1):47-52
references.pmid: 19143005
references.citation: Age Ageing. 2012 Nov;41(6):784-9
references.pmid: 22644078
references.citation: N Engl J Med. 2009 Apr 2;360(14):1418-28
references.pmid: 19339721
references.citation: J Am Geriatr Soc. 2010 Mar;58(3):510-7
references.pmid: 20398120
references.citation: BMC Emerg Med. 2005 Jul 18;5:4
references.pmid: 16026619
references.citation: BMC Health Serv Res. 2011 Jun 17;11:149
references.pmid: 21679471