title: Contribution of the long-term care insurance certificate for predicting 1-year all-cause readmission compared with validated risk scores in elderly patients with heart failure.
abstract: Readmission is a common and serious problem associated with heart failure (HF). Unfortunately, conventional risk models have limited predictive value for predicting readmission. The recipients of long-term care insurance (LTCI) are frail and have mental and physical impairments. We hypothesised that adjustment of the conventional risk score with an LTCI certificate enables a more accurate appreciation of readmission for HF.
  
  
  
  We investigated 452 patients with HF who were followed up for 1 year to determine all-cause readmission. We obtained their clinical and socioeconomic data, including LTCI. The three clinical risk scores used in our evaluation were Keenan (2008), Krumholz (2000) and Charlson (1994). We used net reclassification improvement (NRI) to assess the incremental benefit.
  
  
  
  Patients with LTCI were significantly older, and had a higher prevalence of cerebrovascular disease and dementia than those without LTCI. One-year all-cause readmission (n=193, 43%) was significantly associated with all risk scores, receiving LTCI and the category of LTCI. Receiving LTCI was associated with readmission independent of all risk scores (HR, 1.59 to 1.63; all p<0.01). Adding LTCI to all risk scores led to a significantly improved reclassification, which was observed in the subgroup of patients with HF with preserved ejection fraction (≥50%) but not in the subgroup with reduced ejection fraction (<50%).
  
  
  
  Possession of an LTCI certificate was independently associated with 1-year all-cause readmission after adjusting for validated clinical risk scores in patients with HF. Adding LTCI status significantly improved the model performance for readmission risk, particularly in patients with HF and preserved ejection fraction.
authors.affiliation: Kitaishikai Hospital, Ozu, Japan; Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Kitaishikai Hospital , Ozu , Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Saito
authors.affiliation: Kitaishikai Hospital , Ozu , Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Inaba
authors.affiliation: Kitaishikai Hospital , Ozu , Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Morofuji
authors.affiliation: Kitaishikai Hospital, Ozu, Japan; Ehime University Graduate School of Medicine, Toon, Japan.
authors.forename: Hiroe
authors.initials: H
authors.lastname: Aisu
authors.affiliation: Kitaishikai Hospital , Ozu , Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Sumimoto
authors.affiliation: Uwajima City Hospital , Uwajima , Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Ogimoto
authors.affiliation: Ehime University Graduate School of Medicine , Toon , Japan.
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Ikeda
authors.affiliation: Ehime University Graduate School of Medicine , Toon , Japan.
authors.forename: Jitsuo
authors.initials: J
authors.lastname: Higaki
keywords: HEART FAILURE; Long-term care insurance; Readmission; Risk score