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. 2014 Apr;16(4):419-25.
doi: 10.1002/ejhf.48.

Implantable device diagnostics on day of discharge identify heart failure patients at increased risk for early readmission for heart failure

Roy S Small, David J Whellan, Andrew Boyle, Shantanu Sarkar, Jodi Koehler, Eduardo N Warman, William T Abraham

Implantable device diagnostics on day of discharge identify heart failure patients at increased risk for early readmission for heart failure

Roy S Small et al. Eur J Heart Fail. 2014 Apr.

Abstract

Aims: We hypothesized that diagnostic data in implantable devices evaluated on the day of discharge from a heart failure hospitalization (HFH) can identify patients at risk for HF readmission (HFR) within 30 days.

Methods and results: In this retrospective analysis of four studies enrolling patients with CRT devices, we identified patients with a HFH, device data on the day of discharge, and 30-day post-discharge clinical follow-up. Four diagnostic criteria were evaluated on the discharge day: (i) intrathoracic impedance>8 Ω below reference impedance; (ii) AF burden>6 h; (iii) CRT pacing<90%; and (iv) night heart rate>80 b.p.m. Patients were considered to have higher risk for HFR if ≥2 criteria were met, average risk if 1 criterion was met, and lower risk if no criteria were met. A Cox proportional hazards model was used to compare the groups. The data cohort consisted of a total of 265 HFHs in 175 patients, of which 36 (14%) were followed by HFR. On the discharge day, ≥2 criteria were met in 43 (16% of 265 HFHs), only 1 criterion was met in 92 (35%), and none of the four criteria were met in 130 HFHs (49%); HFR rates were 28, 16, and 7%, respectively. HFH with ≥2 criteria met was five times more likely to have HFR compared with HFH with no criteria met (adjusted hazard ratio 5.0; 95% confidence interval 1.9–13.5, P=0.001).

Conclusion: Device-derived diagnostic criteria evaluated on the day of discharge identified patients at significantly higher risk of HFR.

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Figures

Figure 1
Figure 1
Inclusion and exclusion process to select the final cohort of 175 patients with 265 heart failure hospitalizations (HFH). Thirty-eight patients out of 213 patients with HFH were excluded due to either unavailable device data on the day of discharge or unavailable clinical follow-up data for 30 days post-discharge.
Figure 2
Figure 2
Example cases where (A) no diagnostic criteria were met on the day of discharge and (B) ≥2 diagnostic criteria were met. Diagnostic data are plotted for 30 days prior to discharge and 30 days post-discharge. Occurrence of heart failure hospitalization (HFH) is shaded in grey, with the index event having the discharge day around day 30 on the plots. AT/AV, atrial tachycardia/atrial fibrillation; Avg V. rate, average ventricular rate.
Figure 3
Figure 3
Kaplan–Meier curves showing the readmissions for heart failure (HF) following discharge after an index HF hospitalization for the three groups categorized based on the combination of diagnostic parameters.
See this image and copyright information in PMC

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