title: Risk Stratification Model for 30-Day Heart Failure Readmission in a Multiethnic South East Asian Community.
abstract: There are limited accurate 30-day heart failure (HF) readmission risk scores using readily available clinical patient information on a well-defined HF cohort. We analyzed 1,475 admissions discharged from our hospital with a primary diagnosis of HF between 2010 and 2012. HF diagnostic criteria included satisfying clinical Framingham criteria, elevated serum N-terminal pro-natriuretic peptide, and evidence of cardiac dysfunction on transthoracic echocardiography. The patients were randomly divided into 2 groups; 60% were used as the derivation cohort and 40% as the validation cohort. Bivariate analysis and logistic regression were used to develop the model. Weighted risk scores were derived from the odds ratio of the logistic regression model. Total risk scores were computed by simple summation for each patient. The 7 significant independent predictors of 30-day HF readmission used to derive the risk scoring tool were the number of previous HF-related admission in the preceding 1 year, index admission length of stay, serum creatinine level, electrocardiograph QRS duration, serum N-terminal pro-natriuretic peptide level, number of Medical Social Service needs, and β blocker prescription on discharge. The area under the curve was 0.76. Sensitivity and specificity were 78.3% and 60.7%, respectively. The positive predictive value and negative predictive value were 18.9% and 96%, respectively. The actual observed and predicted 30-day heart failure readmission rates matched. In conclusion, we have developed the first 30-day HF readmission risk score, with good discriminatory ability, for an urban multiethnic Asian heart failure cohort with stringent diagnostic criteria. It consists of 7 easily obtained variables.
authors.affiliation: Department of Cardiology, Changi General Hospital, Singapore, Singapore. Electronic address: drgerardleong@gmail.com.
authors.forename: Kui Toh Gerard
authors.initials: KT
authors.lastname: Leong
authors.affiliation: Health Services Research Department, Eastern Health Alliance, Singapore, Singapore.
authors.forename: Lai Yin
authors.initials: LY
authors.lastname: Wong
authors.affiliation: Health Services Research Department, Eastern Health Alliance, Singapore, Singapore.
authors.forename: Khin Chaw Yu
authors.initials: KC
authors.lastname: Aung
authors.affiliation: Department of Cardiology, Changi General Hospital, Singapore, Singapore.
authors.forename: Michael
authors.initials: M
authors.lastname: Macdonald
authors.affiliation: Case Management, Changi General Hospital, Singapore, Singapore.
authors.forename: Yan
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Cardiology, Changi General Hospital, Singapore, Singapore.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Lee
authors.affiliation: Health Services Research Department, Eastern Health Alliance, Singapore, Singapore.
authors.forename: Wai Leng
authors.initials: WL
authors.lastname: Chow
authors.affiliation: Geisinger Health System, Danville, Pennsylvania.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Doddamani
authors.affiliation: Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore; Department of Cardiology, Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
authors.forename: Arthur Mark
authors.initials: AM
authors.lastname: Richards
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D044466:Asian People; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D020380:Needs Assessment; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010446:Peptide Fragments / Q000097:blood*; D011897:Random Allocation; D015203:Reproducibility of Results; D018570:Risk Assessment; D012846:Singapore
chemical_list: D000319:Adrenergic beta-Antagonists; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D003404:Creatinine