P6544All you need is LE: utility of an abbreviated LACE score in predicting 30-day outcomes among patients hospitalized for Heart Failure (HF)

Background: Length of stay, Acuity, Comorbidities, and Emergency department (ED) visits (LACE) can predict 30-day clinical outcomes when measured at the point of care (POC) in patients hospitalized for HF. However Comorbidities (C) are difficult to score and most patients likely present with high Acuity (A). Purpose: To determine whether an abbreviated LACE score, based only on Length of stay and number of ED visits in the prior 6 months (LE), can reliably predict 30-day readmission and 30-day composite readmission/death when used at the POC in patients hospitalized for HF. Methods: This is a sub-study of the Patient-Centered Care Transitions in HF (PACT-HF) pragmatic stepped wedge cluster randomized trial, which implemented transitional care services for HF across 10 hospitals in Canada. We included patients hospitalized for HF and discharged alive. We measured LACE and LE at the POC, and obtained 30-day clinical outcomes via linkages to administrative databases. We used log-binomial regression models with either LACE or LE as the predictor and either 30-day all-cause readmission or 30-day composite all-cause readmission/death as the outcome. We assessed risk with risk ratios (RR) and 95% confidence intervals (CI); model discrimination with C-statistic; and model calibration with a Hosmer-Lemeshow test. We adjusted all models for PACT-HF services received, and internally validated the models using bootstrapping.