Key result
The addition of echocardiographic diastolic variables to clinical and structural variables significantly improved the prediction of 1-year heart failure readmission, although overall discrimination remained modest (c-statistic 0.63).
Why the study?
Limited data exist on the differential ability of transthoracic echocardiogram variables to predict heart failure readmission across the spectrum of left ventricular systolic function.
Do echocardiographic diastolic variables improve the prediction of 1-year heart failure readmission in patients with recent heart failure compared to clinical and structural variables alone?
Cohort (n=5,900)
No
Do echocardiographic diastolic variables improve the prediction of 1-year heart failure readmission in patients with recent heart failure compared to clinical and structural variables alone?
Effect estimate: c-statistic 0.63 (95% CI 0.54-0.71)
p-value: p=<0.001
Echocardiographic diastolic variables modestly improve the prediction of 1-year heart failure readmission across the LVEF spectrum, though specific predictive structural variables differ between HFrEF and HFpEF.
BACKGROUND: Limited data exist on the differential ability of variables on transthoracic echocardiogram (TTE) to predict heart failure (HF) readmission across the spectrum of left ventricular (LV) systolic function. METHODS: We linked 15 years of TTE report data (1/6/2003-5/3/2018) at Beth Israel Deaconess Medical Center to complete Medicare claims. In those with recent HF, we evaluated the relationship between variables on baseline TTE and HF readmission, stratified by LVEF. RESULTS: After excluding TTEs with uninterpretable diastology, 5,900 individuals (mean age: 76.9 years; 49.1% female) were included, of which 2545 individuals (41.6%) were admitted for HF. Diastolic variables augmented prediction compared to demographics, comorbidities, and echocardiographic structural variables (p < 0.001), though discrimination was modest (c-statistic = 0.63). LV dimensions and eccentric hypertrophy predicted HF in HF with reduced (HFrEF) but not preserved (HFpEF) systolic function, whereas LV wall thickness, NT-proBNP, pulmonary vein D- and Ar-wave velocities, and atrial dimensions predicted HF in HFpEF but not HFrEF (all interaction p < 0.10). Prediction of HF readmission was not different in HFpEF and HFrEF (p = 0.93). CONCLUSIONS: In this single-center echocardiographic study linked to Medicare claims, left ventricular dimensions and eccentric hypertrophy predicted HF readmission in HFrEF but not HFpEF and left ventricular wall thickness predicted HF readmission in HFpEF but not HFrEF. Regardless of LVEF, diastolic variables augmented prediction of HF readmission compared to echocardiographic structural variables, demographics, and comorbidities alone. The additional role of medication adherence, readmission history, and functional status in differential prediction of HF readmission by LVEF category should be considered for future study.
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Hammond et al. (2020) conducted a cohort in Heart failure (n=5,900). Echocardiographic diastolic variables vs. Clinical and structural variables alone was evaluated on Heart failure readmission within 1 year (c-statistic 0.63, 95% CI 0.54-0.71, p=<0.001). The addition of echocardiographic diastolic variables to clinical and structural variables significantly improved the prediction of 1-year heart failure readmission, although overall discrimination remained modest (c-statistic 0.63).
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