Background: Identifying patients with acute heart failure (HF) at high risk for readmission or death after hospital discharge will enable the optimization of treatment and management. The objective of this study was to develop a risk score for 30-day HF-specific readmission or death in Korea. Methods: We analyzed the data from the Korean Acute Heart Failure (KorAHF) registry to develop a risk score. The model was derived from a multiple logistic regression analysis using a stepwise variable selection method. We also proposed a point-based risk score to predict the risk of 30-day HF-specific readmission or death by simply summing the scores assigned to each risk variable. Model performance was assessed using an area under the receiver operating characteristic curve (AUC), the Hosmer–Lemeshow goodness-of-fit test, the net reclassification improvement (NRI), and the integrated discrimination improvement (IDI) index to evaluate discrimination, calibration, and reclassification, respectively. Results: Data from 4566 patients aged ≥40 years were included in the analysis. Among them, 446 (9.8%) had 30-day HF-specific readmission or death. The final model included 12 independent variables (age, New York Heart Association functional class, clinical history of hypertension, HF admission, chronic obstructive pulmonary disease, etiology of cardiomyopathy, systolic blood pressure, left ventricular ejection fraction, serum sodium, brain natriuretic peptide, N-terminal prohormone of brain natriuretic peptide at discharge, and prescription of β-blockers and angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists at discharge). The point risk score showed moderate discrimination (AUC of 0.710; 95% confidence interval, 0.685–0.735) and good calibration (χ2 = 8.540, p = 0.3826). Conclusions: The risk score for the prediction of the risk of 30-day HF-specific readmission or death after hospital discharge was developed using 12 predictors. It can be utilized to guide appropriate interventions or care strategies for patients with HF.
Bibliographical noteFunding Information:
This study was performed under the Korea National Institute of Health intramural research grant 4800-4845-300-210-13 (2016-NI63001-00).
The Korean Acute Heart Failure registry (KorAHF), supported by the Korea National Institute of Health (KNIH), was established in March 2011. It is an ongoing, prospective, observational study conducted at 10 tertiary hospitals to collect data on patients with acute decompensated heart failure. Information on patient characteristics, treatments, and short- and long-term major outcomes was obtained, and the ethnic and regional profiles of the sample were compared with those of other representative HF registries (ADHERE, ATTEND, OPTIMIZE-HF, EHFSII, THESUS-HF, and ADHERE International) [18–20] . The protocol of the KorAHF was approved by the Institutional Review Board of each participating hospital. Written consent was obtained from each patient; if the patient could not agree because of disease severity, informed consent was obtained from a relative or legal representative.
© 2018 The Authors
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine