March 2, 2010Open Access
View Full PaperCritical Elements of Clinical Follow-Up After Hospital Discharge for Heart Failure: Insights from the EVEREST Trial
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).
Study Design
Type
Cohort (n=1,528)
Structured PICO
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?
P
Population
1,528 hospitalized heart failure patients with ejection fraction ≤40% assessed 1 week after discharge, evaluated for 1-year cardiovascular rehospitalization and mortality.
E
Exposure
Prognostic model including physical examination, laboratory results, and Kansas City Cardiomyopathy Questionnaire (KCCQ) assessed 1 week after discharge
C
Comparator
Base prognostic model including only history and medications
O
Outcome
1-year cardiovascular rehospitalization and mortalitycomposite
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.
Main Result
Effect estimate: c-statistic 0.749
p-value: p=<0.001
Abstract
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.