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Validated, electronic health record deployable prediction models for assessing patient risk of 30-day rehospitalization and mortality in older heart failure patients.

Publication ,  Journal Article
Eapen, ZJ; Liang, L; Fonarow, GC; Heidenreich, PA; Curtis, LH; Peterson, ED; Hernandez, AF
Published in: JACC Heart Fail
June 2013

OBJECTIVES: The study sought to derive and validate risk-prediction tools from a large nationwide registry linked with Medicare claims data. BACKGROUND: Few clinical models have been developed utilizing data elements readily available in electronic health records (EHRs) to facilitate "real-time" risk estimation. METHODS: Heart failure (HF) patients ≥ 65 years of age hospitalized in the GWTG-HF (Get With The Guidelines-Heart Failure) program were linked with Medicare claims from January 2005 to December 2009. Multivariable models were developed for 30-day mortality after admission, 30-day rehospitalization after discharge, and 30-day mortality/rehospitalization after discharge. Candidate variables were selected based on availability in EHRs and prognostic value. The models were validated in a 30% random sample and separately in patients with reduced and preserved ejection fraction (EF). RESULTS: Among 33,349 patients at 160 hospitals, 3,002 (9.1%) died within 30 days of admission, 7,020 (22.8%) were rehospitalized within 30 days of discharge, and 8,374 (27.2%) died or were rehospitalized within 30 days of discharge. Compared with patients classified as low risk, high-risk patients had significantly higher odds of death (odds ratio [OR]: 8.82, 95% confidence interval [CI]: 7.58 to 10.26), rehospitalization (OR: 1.99, 95% CI: 1.86 to 2.13), and death/rehospitalization (OR: 2.65, 95% CI: 2.44 to 2.89). The 30-day mortality model demonstrated good discrimination (c-index 0.75) while the rehospitalization and death/rehospitalization models demonstrated more modest discrimination (c-indices of 0.59 and 0.62), with similar performance in the validation cohort and for patients with preserved and reduced EF. CONCLUSIONS: These predictive models allow for risk stratification of 30-day outcomes for patients hospitalized with HF and may provide a validated, point-of-care tool for clinical decision making.

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

June 2013

Volume

1

Issue

3

Start / End Page

245 / 251

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Assessment
  • Prognosis
  • Patient Readmission
  • Models, Theoretical
  • Male
  • Humans
  • Heart Failure
  • Female
  • Electronic Health Records
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Eapen, Z. J., Liang, L., Fonarow, G. C., Heidenreich, P. A., Curtis, L. H., Peterson, E. D., & Hernandez, A. F. (2013). Validated, electronic health record deployable prediction models for assessing patient risk of 30-day rehospitalization and mortality in older heart failure patients. JACC Heart Fail, 1(3), 245–251. https://doi.org/10.1016/j.jchf.2013.01.008
Eapen, Zubin J., Li Liang, Gregg C. Fonarow, Paul A. Heidenreich, Lesley H. Curtis, Eric D. Peterson, and Adrian F. Hernandez. “Validated, electronic health record deployable prediction models for assessing patient risk of 30-day rehospitalization and mortality in older heart failure patients.JACC Heart Fail 1, no. 3 (June 2013): 245–51. https://doi.org/10.1016/j.jchf.2013.01.008.
Eapen ZJ, Liang L, Fonarow GC, Heidenreich PA, Curtis LH, Peterson ED, et al. Validated, electronic health record deployable prediction models for assessing patient risk of 30-day rehospitalization and mortality in older heart failure patients. JACC Heart Fail. 2013 Jun;1(3):245–51.
Eapen, Zubin J., et al. “Validated, electronic health record deployable prediction models for assessing patient risk of 30-day rehospitalization and mortality in older heart failure patients.JACC Heart Fail, vol. 1, no. 3, June 2013, pp. 245–51. Pubmed, doi:10.1016/j.jchf.2013.01.008.
Eapen ZJ, Liang L, Fonarow GC, Heidenreich PA, Curtis LH, Peterson ED, Hernandez AF. Validated, electronic health record deployable prediction models for assessing patient risk of 30-day rehospitalization and mortality in older heart failure patients. JACC Heart Fail. 2013 Jun;1(3):245–251.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

June 2013

Volume

1

Issue

3

Start / End Page

245 / 251

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Assessment
  • Prognosis
  • Patient Readmission
  • Models, Theoretical
  • Male
  • Humans
  • Heart Failure
  • Female
  • Electronic Health Records