Key result
Adding physical examination, laboratory, and KCCQ results 1 week after discharge to a base model improved prediction of 1-year cardiovascular rehospitalization and mortality (c-statistic 0.749).
Why the study?
Does the addition of physical examination, laboratory results, and KCCQ assessments 1 week after discharge improve the prediction of 1-year cardiovascular rehospitalization and mortality in hospitalized heart failure patients?
Cohort (n=1,528)
Does the addition of physical examination, laboratory results, and KCCQ assessments 1 week after discharge improve the prediction of 1-year cardiovascular rehospitalization and mortality in hospitalized heart failure patients?
Effect estimate: c-statistic 0.749
p-value: p=<0.001
Physical examination, laboratory tests, and KCCQ assessments performed 1 week after heart failure hospitalization discharge provide significant incremental prognostic value for predicting 1-year mortality and rehospitalization.
May enhance post-discharge risk stratification in HFrEF; leaves open whether targeted interventions improve outcomes.
AIMS: Hospitalized heart failure (HF) patients are at high risk for death and readmission. We examined the incremental value of data obtained 1 week after HF hospital discharge in predicting mortality and readmission. METHODS AND RESULTS: In the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with tolvaptan, 1528 hospitalized patients (ejection fraction < or =40%) with a physical examination, laboratories, and health status [Kansas City Cardiomyopathy Questionnaire (KCCQ)] assessments 1 week after discharge were included. The ability to predict 1 year cardiovascular rehospitalization and mortality was assessed with Cox models, c-statistics, and the integrated discrimination improvement (IDI). Not using a beta-blocker, rales, pedal oedema, hyponatraemia, lower creatinine clearance, higher brain natriuretic peptide, and worse health status were independent risk factors for rehospitalization and death. The c-statistic for the base model (history and medications) was 0.657. The model improved with physical examination, laboratory, and KCCQ results, with IDI increases of 4.9, 7.0, and 3.2%, respectively (P < 0.001 each). The combination of all three offered the greatest incremental gain (c-statistic 0.749; IDI increase 10.8%). CONCLUSION: Physical examination, laboratories, and KCCQ assessed 1 week after discharge offer important prognostic information, suggesting that all are critical components of outpatient evaluation after HF hospitalization.
No takes yet. Share an insight, caveat, or question.
Dunlay et al. (2010) conducted a cohort in Heart failure (n=1,528). Physical examination, laboratory, and KCCQ assessments 1 week after discharge vs. Base model (history and medications) was evaluated on 1 year cardiovascular rehospitalization and mortality (c-statistic 0.749, p=<0.001). Adding physical examination, laboratory, and KCCQ results 1 week after discharge to a base model improved prediction of 1-year cardiovascular rehospitalization and mortality (c-statistic 0.749).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: