An absolute risk prediction model to determine unplanned cardiovascular readmissions for adults with chronic heart failure
Carrington, MJ; Davidson, PM; Frost, SA; Chan, YK; Newton, PJ; Betihavas, V; Macdonald, P; Stewart, S
Abstract
BACKGROUND:
Frequent readmissions are a hallmark of chronic heart failure (CHF). We sought to develop an absolute risk prediction model for unplanned cardiovascular readmissions following hospitalisation for CHF.
METHODS:
An inception cohort was obtained from the WHICH? trial, a prospective, multi-centre randomised controlled trial which was a head-to-head comparison of the efficacy of a home-based intervention versus clinic-based intervention for adults with CHF. A Cox's proportional hazards model (taking into account the competing risk of death) was used to develop a prediction model. Bootstrap methods were used to identify factors for the final model. Based on these data a nomogram was developed.
RESULTS:
Of the 280 participants in the WHICH? trial 37 (13%) were readmitted for a cardiovascular event (including CHF) within 28 days, and a further 149 (53%) were readmitted within 18 months for a cardiovascular event. In the proposed competing risk model, factors associated with an increased risk of hospitalisation for CHF were: age (HR 1.07, 95% CI 0.90-1.26) for each 10-year increase in age; living alone (HR 1.09, 95% CI 0.74-1.59); those with a sedentary lifestyle (HR 1.44, 95% CI, 0.92-2.25) and the presence of multiple co-morbid conditions (HR 1.69, 95% CI 0.38-7.58) for five or more co-morbid conditions (compared to individuals with one documented co-morbidity). The C-statistic of the final model was 0.80.
CONCLUSION:
We have developed a practical model for individualising the risk of short-term readmission for CHF. This model may provide additional information for targeting and tailoring interventions and requires future prospective evaluation.
| Journal | HEART LUNG CIRC |
| ISSN | 1443-9506 |
| Published | 01 Nov 2015 |
| Volume | 24 |
| Issue | 11 |
| Pages | 1068-73 |
| DOI | 10.1016/j.hlc.2015.04.168 |
| Type | Journal Article |
| Sponsorship |