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Prediction of 30-Day Heart Failure-Specific Readmission Risk by Echocardiographic Parameters

Citation

Thavendiranathan, P and Yingchoncharoen, T and Grant, A and Seicean, S and Landers, SH and Gorodeski, EZ and Marwick, TH, Prediction of 30-Day Heart Failure-Specific Readmission Risk by Echocardiographic Parameters, The American Journal of Cardiology, 113, (2) pp. 335-341. ISSN 0002-9149 (2014) [Refereed Article]

Copyright Statement

Copyright 2014 Elsevier Inc.

DOI: doi:10.1016/j.amjcard.2013.09.025

Abstract

It is unknown whether echocardiographic morphologic and hemodynamic parameters have incremental value in predicting 30-day heart failure (HF)-specific readmission risk among patients admitted with HF. We performed a prospective cohort study of adult patients entering a transitional care program after HF hospitalization to assess the role of echocardiographic parameters in predicting 30-day HF-specific readmission risk. Patients were followed for at least 30 days postdischarge, and readmission outcomes were ascertained prospectively. A previously validated 30-day HF readmission score (Yale Center for Outcome Research and Evaluation [CORE]) was calculated using 20 clinical and pathology parameters. Atrial and ventricular morphologic and hemodynamic variables were obtained from the index hospitalization echocardiogram. A Cox proportional hazards model was used to identify variables associated with 30-day HF specific readmission risk. Among 283 patients (mean age 72 14 years, 57% men, 54% ischemic HF, ejection fraction 35% 17%) who underwent echocardiography during index admission there were 46 HF specific readmissions. After risk adjustment, elevated echocardiographic right atrial pressure (RAP; hazard ratio [HR] 3.70, 95% confidence interval [CI] 1.82 to 7.52, p <0.001), left ventricular filling pressures (HR 7.46, 95% CI 2.31 to 24.14, p = 0.001), and weight change during admission (HR 0.93, 95% CI 0.87 to 0.99, p = 0.02) were independently associated with 30-day HF-specific readmission risk. However, only elevated RAP and left ventricular filling pressure added incremental prognostic value to the Yale-CORE HF readmission score. An E/e' threshold of 23 identified a subgroup at highest risk of readmission and provided a net 29% reclassification improvement over the Yale-CORE HF readmission score (p = 0.005).

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:87759
Year Published:2014
Web of Science® Times Cited:15
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-12-04
Last Modified:2017-10-31
Downloads:0

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