Author + information
- Song Li,
- Julio Nunez,
- Eduardo Nunez,
- Juan Sanchis and
- Wayne C. Levy
Background: Whether ambulatory heart failure (HF) risk models can be accurately applied to patients being discharged after acute HF hospitalization is unknown. The goal of the present study is to evaluate the performance of the Seattle Heart Failure Model (SHFM) in this population.
Methods: A total of 2,242 consecutive patients being discharged after acute HF hospitalization were analyzed. Model discrimination was assessed by 1-year area under the receiver operating characteristic curve (ROC AUC). Model calibration was assessed by comparing actual versus predicted survival at 1 to 5 years. The hazard ratios (HR) of post discharge status for different age groups and time periods after discharge were calculated using Cox regression model comparing our study cohort and the original SHFM cohorts.
Results: The average age of our study cohort was 73, 50% female, LVEF 50%, and median NYHA class II. In patients discharged after acute HF hospitalization, the SHFM provided adequate discrimination with a 1-year ROC AUC of 0.704. Actual survival was lower than predicted by the SHFM (82% vs 91% at 1 year; 48% vs 64% at 5 years). The increased post discharge mortality was only observed in patients ≥ 65 years old with a stepwise increase in HR with each advancing age group (0.95 for age < 65, 1.34 for age 65-69, 1.41 for age 70-74, 1.63 for age 75-79, 2.36 for age ≥ 80, nonsignificant for age < 65, p < 0.005 for all other groups). In addition, the HR for increased post discharge mortality diminished over time after discharge and was nonsignificant after 18 months (2.00 for < 6 months, 1.73 for 6-12 months, 1.63 for 12-18 months, 1.24 for 18-24 months, 1.36 for > 24 months, p < 0.001 for all periods < 18 months, nonsignificant afterwards).
Conclusions: The SHFM discriminated mortality risk in patients being discharged after acute HF hospitalization. Model calibration was appropriate for younger patients (< 65 years old). Patients ≥ 65 years old had higher than predicted mortality for up to 18 months after discharge. This pattern is consistent with the well-described post-hospital syndrome and may be related to higher prevalence of comorbidities in older HF patients or misclassification of NYHA class at hospital discharge.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Heart Failure: Evaluating Strategies to Prevent Readmissions
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1163-269
- 2017 American College of Cardiology Foundation