Electronic medical record-derived psychosocial vulnerability and unplanned readmission after percutaneous coronary intervention in heart failure

BACKGROUNDPatients with heart failure (HF) undergoing percutaneous coronary intervention (PCI) are at high risk of early rehospitalisation, but psychosocial vulnerability is seldom incorporated into routine risk assessment.We hypothesised that an electronic medical record (EMR)-derived psychosocial vulnerability index (EVI) would be independently associated with early unplanned readmission after discharge. AIMTo determine whether an EVI predicts unplanned readmission after PCI in HF. METHODSThis single-centre retrospective cohort included 400 adults with HF who survived PCI discharge between 2020 and 2024 at a tertiary hospital in China.EVI was scored from three routine-data domains: (1) Mental health; (2) Cognitive/functional vulnerability; and (3) Social/economic proxies.High EVI was defined as ≥ 2.Propensity scores used age, left ventricular ejection fraction, chronic kidney disease, prior hospitalisation, and diabetes mellitus.One-to-one matching yielded 100 high-EVI and 100 Low-EVI patients.Conditional logistic regression, competing-risk methods, and stratified Cox models were used. RESULTSBefore matching, 102 patients (25.5%) had high EVI.In the matched cohort, 90-day unplanned readmission occurred in 38 high-EVI patients and 25 low-EVI patients (38.0%vs 25.0%; conditional odds ratio = 1.84, 95%CI: 1.06-3.20;P = 0.03).Cumulative incidence functions treating death as a competing event were consistent (Gray P = 0.03).High EVI was also associated with 365-day mortality (22.0%vs 13.0%; hazard ratio = 1.75, 95%CI: 1.02-2.99;P = 0.04) and 365-day readmission or death (55.0%vs 4 / 50 40.0%;hazard ratio = 1.58, 95%CI: 1.08-2.32;P = 0.02). CONCLUSIONThe EMR-derived index identifies higher-risk patients after PCI for HF, but external validation in diverse settings is required.