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. 2020 Jun 24:13:539-547.
doi: 10.2147/JMDH.S255206. eCollection 2020.

Composite Outcomes of Mortality and Readmission in Patients with Heart Failure: Retrospective Review of Administrative Datasets

Afsaneh Roshanghalb  1 , Cristina Mazzali  2 , Emanuele Lettieri  1
Affiliations

Composite Outcomes of Mortality and Readmission in Patients with Heart Failure: Retrospective Review of Administrative Datasets

Afsaneh Roshanghalb et al. J Multidiscip Healthc. .

Abstract

Background: Controlling the quality of care through readmissions and mortality for patients with heart failure (HF) is a national priority for healthcare regulators in developed countries. In this longitudinal cohort study, using administrative data such as hospital discharge forms (HDFs), emergency departments (EDs) accesses, and vital statistics, we test new covariates for predicting mortality and readmissions of patients hospitalized for HF and discuss the use of combined outcome as an alternative.

Methods: Logistic models, with a stepwise selection method, were estimated on 70% of the sample and validated on the remaining 30% to evaluate 30-day mortality, 30-day readmissions, and the combined outcome. We followed an extraction method for any-cause mortality and unplanned readmission within 30 days after incident HF hospitalization. Data on patient admission and previous history were extracted by HDFs and ED dataset.

Results: Our principal findings demonstrate that the model's discriminant ability is consistent with literature both for mortality (AUC=0.738, CI (0.729-0.748)) and readmissions (AUC=0.578, CI (0.562-0.594)). Additionally, the discriminant ability of the composite outcome model is satisfactory (AUC=0.675, CI (0.666-0.684)).

Conclusion: Hospitalization characteristics and patient history introduced in the logistic models do not improve their discriminant ability. The composite outcome prediction is led more by mortality than readmission, without improvements for the comprehension of the readmission phenomenon.

Keywords: administrative health data; heart failure; mortality; patient readmission.

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Conflict of interest statement

Dr Emanuele Lettieri reports grants from Italian Ministry of Health and Lombardy Region, during the conduct of the study. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Receiver Operator Characteristic (ROC) curves for mortality, readmission, and composite outcome of mortality and readmission at 30 days. AUC indicates area under the curve (Mann–Whitney U-Statistic); 95% confidence interval for mortality ROC (0.7297 to 0.7480), readmission ROC (0.5615 to 0.5939), and composite outcome of mortality and readmission (0.6660 to 0.6839).
See this image and copyright information in PMC

References

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