title: A simple validated method for predicting the risk of hospitalization for worsening of heart failure in ambulatory patients: the Redin-SCORE.
abstract: OBJECTIVE
  Prevention of hospital readmissions is one of the main objectives in the management of patients with heart failure (HF). Most of the models predicting readmissions are based on data extracted from hospitalized patients rather than from outpatients. Our objective was to develop a validated score predicting 1-month and 1-year risk of readmission for worsening of HF in ambulatory patients.
  
  
  RESULTS
  A cohort of 2507 ambulatory patients with chronic HF was prospectively followed for a median of 3.3 years. Clinical, echocardiographic, ECG, and biochemical variables were used in a competing risk regression analysis to construct a risk score for readmissions due to worsening of HF. Thereafter, the score was externally validated using a different cohort of 992 patients with chronic HF (MUSIC registry). Predictors of 1-month readmission were the presence of elevated natriuretic peptides, left ventricular (LV) HF signs, and estimated glomerular filtration rate (eGFR) <60 mL/min/m(2) . Predictors of 1-year readmission were elevated natriuretic peptides, anaemia, left atrial size >26 mm/m(2) , heart rate >70 b.p.m., LV HF signs, and eGFR <60 mL/min/m(2) . The C-statistics for the models were 0.72 and 0.66, respectively. The cumulative incidence function distinguished low-risk (<1% event rate) and high-risk groups (>5% event rate) for 1-month HF readmission. Likewise, low-risk (7.8%), intermediate-risk (15.6%) and high-risk groups (26.1%) were identified for 1-year HF readmission risk. The C-statistics remained consistent after the external validation (<5% loss of discrimination).
  
  
  CONCLUSIONS
  The Redin-SCORE predicts early and late readmission for worsening of HF using proven prognostic variables that are routinely collected in outpatient management of chronic HF.
authors.affiliation: Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Álvarez-García
authors.affiliation: Epidemiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Andreu
authors.initials: A
authors.lastname: Ferrero-Gregori
authors.affiliation: Epidemiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Puig
authors.affiliation: Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Vázquez
authors.affiliation: Cardiology Department, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado
authors.affiliation: Cardiology Department, Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual-Figal
authors.affiliation: Cardiology Department, Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Alonso-Pulpón
authors.affiliation: Cardiology Department, Hospital Clínico, Santiago de Compostela, Spain.
authors.forename: José R
authors.initials: JR
authors.lastname: González-Juanatey
authors.affiliation: Cardiology Department, Hospital La Fe, Valencia, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Rivera
authors.affiliation: Cardiology Department, Hospital Arnau de Vilanova, Lleida, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Worner
authors.affiliation: Cardiology Department, Hospital Juan XXIII, Tarragona, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Bardají
authors.affiliation: Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
mesh_terms: D000208:Acute Disease; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D010045:Outpatients; D010359:Patient Readmission / Q000706:statistics & numerical data*
keywords: Competing risk; Death; Heart failure; Readmission; Score