Author + information
- Benjamin Davies Horne,
- Jason Lappe,
- Abdallah Kfoury,
- Deborah Budge,
- Rami Alharethi,
- Jeffrey Anderson,
- Kimberly Brunisholz,
- Joseph B. Muhlestein,
- Heidi May,
- Tami Bair and
- Donald Lappe
Innovative strategies and tools for stratification of 30-day readmission (30dR) risk are needed due to penalties legislated in the Affordable Care Act (ACA). The Intermountain Risk Score (IMRS) is a sex-specific tool derived to predict mortality using the complete blood count (CBC), basic metabolic profile (BMP), and age. IMRS also predicts incident heart failure (HF), but its ability to predict 30dR is unknown.
Patients discharged with a primary ICD-9 diagnosis of HF from an Intermountain Healthcare hospital (4/1999-4/2011) were studied to test IMRS for all-cause 30dR (N=6616) and to derive a new risk score (IMRS-HF) for 30dR. Recent patients (hospitalized 4/2011-10/2012) validated IMRS-HF (N=459). Age, sex, length of stay, and components of the CBC, BMP, and Charlson Index were evaluated by sex-specific Cox regression for use in IMRS-HF, with beta-coefficients used to assign risk values.
IMRS predicted mortality (c=0.70, p<0.001), but was weak for 30dR (c=0.54, p=0.001). In derivation patients, IMRS-HF predicted 30dR for females (n=3461, IMRS-HF range: 0-9) with hazard ratio (HR)=1.22 per +1 score (95% Cl=1.16, 1.29; p<0.001) and for males (n=3155, IMRS-HF range: 1-19) with HR=1.25 per +1 score (Cl=1.19, 1.31; p<0.001). Highest vs. lowest IMRS-HF groups were substantially stratified (females: HR=5.15 for scores 7-9 [24% 30dR] vs. 0 [5% 30dR]; males: HR=4.47 for 15-19 [22% 30dR] vs. 1-8 [6% 30dR]). C-statistics were c=0.604 (p<0.001) for females and 0.636 (p<0.001) for males. In validation patients, females (n=169) had HR=2.13 (p=0.14) for scores 5-9 (16% 30dR) vs. 0-3 (8% 30dR) and HR=3.37 (p=0.019) for 4 (25% 30dR) vs. 0-3 with c=0.566 (p=0.31), and males (n=290) had HR=8.58 (p=0.041) for scores 15-19 (28% 30dR) vs. 1-8 (4% 30dR) with step-wise risk (HR=1.23 per +1 score, p=0.004; c=0.649, p=0.005).
IMRS only weakly predicted 30dR in HF patients. In contrast, 30dR was significantly stratified by IMRS-HF, a new clinical decision tool. IMRS-HF was validated in an independent population, with especially strong findings among males. IMRS-HF may be useful for in-hospital care aimed at preventing readmission and avoiding ACA reimbursement penalties.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Lessons Learned from Acute Decompensated Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1175-280
- 2013 American College of Cardiology Foundation