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Multicenter Study
. 2021 Aug;8(4):2690-2697.
doi: 10.1002/ehf2.13324. Epub 2021 May 1.

Derivation and validation of a two-variable index to predict 30-day outcomes following heart failure hospitalization

Tauben Averbuch  1   2 , Shun Fu Lee  2 , Mamas Andreas Mamas  3 , Urun Erbas Oz  4 , Richard Perez  4 , Stuart James Connolly  1   2 , Dennis Tien-Wei Ko  5   6 , Harriette Gillian Christine Van Spall  1   2   4   7
Affiliations
Multicenter Study

Derivation and validation of a two-variable index to predict 30-day outcomes following heart failure hospitalization

Tauben Averbuch et al. ESC Heart Fail. 2021 Aug.

Abstract

Background: The LACE index-length of stay (L), acuity (A), Charlson co-morbidities (C), and emergent visits (E)-predicts 30-day outcomes following heart failure (HF) hospitalization but is complex to score. A simpler LE index (length of stay and emergent visits) could offer a practical advantage in point-of-care risk prediction.

Methods and results: This was a sub-study of the patient-centred care transitions in HF (PACT-HF) multicentre trial. The derivation cohort comprised patients hospitalized for HF, enrolled in the trial, and followed prospectively. External validation was performed retrospectively in a cohort of patients hospitalized for HF. We used log-binomial regression models with LACE or LE as the predictor and either 30-day composite all-cause readmission or death or 30-day all-cause readmission as the outcomes, adjusting only for post-discharge services. There were 1985 patients (mean [SD] age 78.1 [12.1] years) in the derivation cohort and 378 (mean [SD] age 73.1 [13.2] years) in the validation cohort. Increments in the LACE and LE indices were associated with 17% (RR 1.17; 95% CI 1.12, 1.21; C-statistic 0.64) and 21% (RR 1.21; 95% CI 1.15, 1.26; C-statistic 0.63) increases, respectively, in 30-day composite all-cause readmission or death; and 16% (RR 1.16; 95% CI 1.11, 1.20; C-statistic 0.64) and 18% (RR 1.18; 95% CI 1.13, 1.24; C-statistic 0.62) increases, respectively, in 30-day all-cause readmission. The LE index provided better risk discrimination for the 30-day outcomes than did the LACE index in the external validation cohort.

Conclusions: The LE index predicts 30-day outcomes following HF hospitalization with similar or better performance than the more complex LACE index.

Trial registration: ClinicalTrials.gov NCT02112227.

Keywords: Heart failure; Readmission; Risk prediction.

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Conflict of interest statement

Dr Van Spall has received research salary support from Ontario's Ministry of Health, Hamilton Health Sciences Career Award, Women As One Escalator Award, and McMaster University Department of Medicine. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1
Figure 1
Scoring and performance of the LE index to predict 30‐day outcomes in patients hospitalized for HF. In a sub‐study of the Patient‐centred Care Transitions in Heart Failure multicentre trial, the LE index, comprising length of stay (L) and number of ED visits in preceding 6 months (E), predicted 30‐day outcomes in patients hospitalized for HF with similar performance as the more complex LACE index. The index was externally validated in a separate cohort.
Figure 2
Figure 2
Receiver operating characteristic curve analysis of LE index thresholds in predicting 30‐day composite all‐cause readmission or death in 1985 patients hospitalized for HF. A threshold LE index of ≥7 has optimal sensitivity and specificity for predicting 30‐day composite all‐cause readmission or death in patients hospitalized for HF.
See this image and copyright information in PMC

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