Mamas Mamas m.mamas@keele.ac.uk
Derivation and validation of a two-variable index to predict 30-day outcomes following heart failure hospitalization
Mamas
Authors
Abstract
Background
The LACE index—length of stay (L), acuity (A), Charlson co-morbidities (C), and emergent visits (E)—predicts 30-day outcomes following heart failure (HF) hospitalization but is complex to score. A simpler LE index (length of stay and emergent visits) could offer a practical advantage in point-of-care risk prediction.
Methods and results
This was a sub-study of the patient-centred care transitions in HF (PACT-HF) multicentre trial. The derivation cohort comprised patients hospitalized for HF, enrolled in the trial, and followed prospectively. External validation was performed retrospectively in a cohort of patients hospitalized for HF. We used log-binomial regression models with LACE or LE as the predictor and either 30-day composite all-cause readmission or death or 30-day all-cause readmission as the outcomes, adjusting only for post-discharge services. There were 1985 patients (mean [SD] age 78.1 [12.1] years) in the derivation cohort and 378 (mean [SD] age 73.1 [13.2] years) in the validation cohort. Increments in the LACE and LE indices were associated with 17% (RR 1.17; 95% CI 1.12, 1.21; C-statistic 0.64) and 21% (RR 1.21; 95% CI 1.15, 1.26; C-statistic 0.63) increases, respectively, in 30-day composite all-cause readmission or death; and 16% (RR 1.16; 95% CI 1.11, 1.20; C-statistic 0.64) and 18% (RR 1.18; 95% CI 1.13, 1.24; C-statistic 0.62) increases, respectively, in 30-day all-cause readmission. The LE index provided better risk discrimination for the 30-day outcomes than did the LACE index in the external validation cohort.
Conclusions
The LE index predicts 30-day outcomes following HF hospitalization with similar or better performance than the more complex LACE index.
Journal Article Type | Article |
---|---|
Acceptance Date | Mar 19, 2021 |
Online Publication Date | May 1, 2021 |
Publication Date | 2021-08 |
Journal | ESC Heart Failure |
Print ISSN | 2055-5822 |
Publisher | Wiley Open Access |
Peer Reviewed | Peer Reviewed |
Volume | 8 |
Issue | 4 |
Pages | 2690-2697 |
DOI | https://doi.org/10.1002/ehf2.13324 |
Keywords | Heart failure; Risk prediction; Readmission |
Publisher URL | https://onlinelibrary.wiley.com/doi/10.1002/ehf2.13324 |
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Publisher Licence URL
https://creativecommons.org/licenses/by-nc/4.0/
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