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Prediction of 30-Day Heart Failure-Specific Readmission Risk by Echocardiographic Parameters
journal contributionposted on 2023-05-17, 20:53 authored by Thavendiranathan, P, Yingchoncharoen, T, Grant, A, Seicean, S, Landers, SH, Gorodeski, EZ, Thomas MarwickThomas Marwick
It is unknown whether echocardiographic morphologic and hemodynamic parameters have incremental value in predicting 30-day heart failure (HF)-specific readmission risk among patients admitted with HF. We performed a prospective cohort study of adult patients entering a transitional care program after HF hospitalization to assess the role of echocardiographic parameters in predicting 30-day HF-specific readmission risk. Patients were followed for at least 30 days postdischarge, and readmission outcomes were ascertained prospectively. A previously validated 30-day HF readmission score (Yale Center for Outcome Research and Evaluation [CORE]) was calculated using 20 clinical and pathology parameters. Atrial and ventricular morphologic and hemodynamic variables were obtained from the index hospitalization echocardiogram. A Cox proportional hazards model was used to identify variables associated with 30-day HF specific readmission risk. Among 283 patients (mean age 72 ± 14 years, 57% men, 54% ischemic HF, ejection fraction 35% ± 17%) who underwent echocardiography during index admission there were 46 HF specific readmissions. After risk adjustment, elevated echocardiographic right atrial pressure (RAP; hazard ratio [HR] 3.70, 95% confidence interval [CI] 1.82 to 7.52, p <0.001), left ventricular filling pressures (HR 7.46, 95% CI 2.31 to 24.14, p = 0.001), and weight change during admission (HR 0.93, 95% CI 0.87 to 0.99, p = 0.02) were independently associated with 30-day HF-specific readmission risk. However, only elevated RAP and left ventricular filling pressure added incremental prognostic value to the Yale-CORE HF readmission score. An E/e' threshold of 23 identified a subgroup at highest risk of readmission and provided a net 29% reclassification improvement over the Yale-CORE HF readmission score (p = 0.005).
Publication titleThe American Journal of Cardiology
Department/SchoolMenzies Institute for Medical Research
PublisherExcerpta Medica Inc
Place of publication650 Avenue Of The Americas, New York, USA, Ny, 10011
Rights statementCopyright 2014 Elsevier Inc.