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Improved 30 day heart failure rehospitalization prediction through the addition of device‐measured parameters
AIMS: This study aimed to improve in‐person clinical evaluation on the day of heart failure (HF) hospitalization discharge by adding device‐measured parameters to predict 30 day HF rehospitalization risk in cardiac resynchronization therapy‐defibrillator (CRT‐D) patients. METHODS AND RESULTS: In a c...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754918/ https://www.ncbi.nlm.nih.gov/pubmed/32924322 http://dx.doi.org/10.1002/ehf2.12956 |
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author | Brown, Jason R. Alonso, Alvaro Mazimba, Sula Warman, Eduardo N. Bilchick, Kenneth C. |
author_facet | Brown, Jason R. Alonso, Alvaro Mazimba, Sula Warman, Eduardo N. Bilchick, Kenneth C. |
author_sort | Brown, Jason R. |
collection | PubMed |
description | AIMS: This study aimed to improve in‐person clinical evaluation on the day of heart failure (HF) hospitalization discharge by adding device‐measured parameters to predict 30 day HF rehospitalization risk in cardiac resynchronization therapy‐defibrillator (CRT‐D) patients. METHODS AND RESULTS: In a cohort of Medicare patients with CRT‐Ds, the independent prognostic value of four device‐measured parameters was assessed relative to typical clinical parameters associated with rehospitalization risk. Medicare registry, claims, and Medtronic CareLink® Network data for these patients were analysed using logistic regression modelling and net reclassification methods. Among 1563 CRT‐D patients, 411 patients had 607 HF hospitalization events during a median 6.3 years of follow‐up. Compared with clinical variables alone, impedance measurements resulted in a 28% improvement between the predicted probabilities of having vs. not having a 30 day HF rehospitalization (relative integrated discrimination improvement = 0.28) and a net 42% improvement in the classification of 30 day HF rehospitalization events and non‐events after an index HF hospitalization (net reclassification index = 0.42; 95% CI: 0.10, 0.74). CONCLUSIONS: In CRT patients, intrathoracic impedance measurements improve prediction of 30 day HF rehospitalization over clinical characteristics alone. The present study provides supportive data for the routine evaluation of intrathoracic impedance prior to discharge in patient with CRT devices. Furthermore, the models developed in this study could be used to design interventions to improve compliance with Medicare reimbursement guidelines regarding 30 day HF rehospitalization. |
format | Online Article Text |
id | pubmed-7754918 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-77549182020-12-23 Improved 30 day heart failure rehospitalization prediction through the addition of device‐measured parameters Brown, Jason R. Alonso, Alvaro Mazimba, Sula Warman, Eduardo N. Bilchick, Kenneth C. ESC Heart Fail Original Research Articles AIMS: This study aimed to improve in‐person clinical evaluation on the day of heart failure (HF) hospitalization discharge by adding device‐measured parameters to predict 30 day HF rehospitalization risk in cardiac resynchronization therapy‐defibrillator (CRT‐D) patients. METHODS AND RESULTS: In a cohort of Medicare patients with CRT‐Ds, the independent prognostic value of four device‐measured parameters was assessed relative to typical clinical parameters associated with rehospitalization risk. Medicare registry, claims, and Medtronic CareLink® Network data for these patients were analysed using logistic regression modelling and net reclassification methods. Among 1563 CRT‐D patients, 411 patients had 607 HF hospitalization events during a median 6.3 years of follow‐up. Compared with clinical variables alone, impedance measurements resulted in a 28% improvement between the predicted probabilities of having vs. not having a 30 day HF rehospitalization (relative integrated discrimination improvement = 0.28) and a net 42% improvement in the classification of 30 day HF rehospitalization events and non‐events after an index HF hospitalization (net reclassification index = 0.42; 95% CI: 0.10, 0.74). CONCLUSIONS: In CRT patients, intrathoracic impedance measurements improve prediction of 30 day HF rehospitalization over clinical characteristics alone. The present study provides supportive data for the routine evaluation of intrathoracic impedance prior to discharge in patient with CRT devices. Furthermore, the models developed in this study could be used to design interventions to improve compliance with Medicare reimbursement guidelines regarding 30 day HF rehospitalization. John Wiley and Sons Inc. 2020-09-13 /pmc/articles/PMC7754918/ /pubmed/32924322 http://dx.doi.org/10.1002/ehf2.12956 Text en © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Articles Brown, Jason R. Alonso, Alvaro Mazimba, Sula Warman, Eduardo N. Bilchick, Kenneth C. Improved 30 day heart failure rehospitalization prediction through the addition of device‐measured parameters |
title | Improved 30 day heart failure rehospitalization prediction through the addition of device‐measured parameters |
title_full | Improved 30 day heart failure rehospitalization prediction through the addition of device‐measured parameters |
title_fullStr | Improved 30 day heart failure rehospitalization prediction through the addition of device‐measured parameters |
title_full_unstemmed | Improved 30 day heart failure rehospitalization prediction through the addition of device‐measured parameters |
title_short | Improved 30 day heart failure rehospitalization prediction through the addition of device‐measured parameters |
title_sort | improved 30 day heart failure rehospitalization prediction through the addition of device‐measured parameters |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754918/ https://www.ncbi.nlm.nih.gov/pubmed/32924322 http://dx.doi.org/10.1002/ehf2.12956 |
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