Added value of frailty and social support in predicting risk of 30-day unplanned re-admission or death for patients with heart failure

An analysis from OPERA-HF

I Sokoreli, J G Cleland, S C Pauws, E W Steyerberg, J J G de Vries, J M Riistama, K Dobbs, J Bulemfu, A L Clark

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background: Models for predicting the outcome of patients hospitalized for heart failure (HF) rarely take a holistic view. We assessed the ability ofmeasures of frailty and social support in addition to demographic, clinical, imaging and laboratory variables to predict short-term outcome for patients discharged after a hospitalization for HF.

Methods: OPERA-HF is a prospective observational cohort, enrolling patients hospitalized for HF in a single center in Hull, UK. Variables were combined in a logistic regression model after multiple imputation of missing data to predict the composite outcome of death or readmission at 30 days. Comparisons were made to a model using clinical variables alone. The discriminative performance of each model was internally validated with bootstrap re-sampling.

Results: 1094 patients were included (mean age 77 [interquartile range 68-83] years; 40% women; 56% with moderate to severe left ventricular systolic dysfunction) of whom 213 (19%) had an unplanned re-admission and 60 (5%) died within 30 days. For the composite outcome, a model containing clinical variables alone had an area under the receiver-operating characteristic curve (AUC) of 0.68 [95% CI 0.64-0.72]. Adding marital status, support from family and measures of physical frailty increased the AUC (p <0.05) to 0.70 [95% CI 0.66-0.74].

Conclusions: Measures of physical frailty and social support improve prediction of 30-day outcome after an admission for HF but predicting near-term events remains imperfect. Further external validation and improvement of the model is required. (c) 2018 Elsevier B. V. All rights reserved.

Original languageEnglish
Pages (from-to)167-172
Number of pages6
JournalInternational Journal of Cardiology
Volume278
DOIs
Publication statusPublished - 1 Mar 2019

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Area Under Curve
Logistic Models
Marital Status

Keywords

  • 30-day re-admission
  • ANXIETY
  • DEPRESSION
  • DIAGNOSIS
  • DISEASE
  • Frailty
  • GO
  • Heart failure
  • MODELS
  • MORTALITY
  • Mortality
  • Psychosocial factors
  • READMISSION

Cite this

@article{c419342fd63f442ea41e84b17a666b35,
title = "Added value of frailty and social support in predicting risk of 30-day unplanned re-admission or death for patients with heart failure: An analysis from OPERA-HF",
abstract = "Background: Models for predicting the outcome of patients hospitalized for heart failure (HF) rarely take a holistic view. We assessed the ability ofmeasures of frailty and social support in addition to demographic, clinical, imaging and laboratory variables to predict short-term outcome for patients discharged after a hospitalization for HF.Methods: OPERA-HF is a prospective observational cohort, enrolling patients hospitalized for HF in a single center in Hull, UK. Variables were combined in a logistic regression model after multiple imputation of missing data to predict the composite outcome of death or readmission at 30 days. Comparisons were made to a model using clinical variables alone. The discriminative performance of each model was internally validated with bootstrap re-sampling.Results: 1094 patients were included (mean age 77 [interquartile range 68-83] years; 40{\%} women; 56{\%} with moderate to severe left ventricular systolic dysfunction) of whom 213 (19{\%}) had an unplanned re-admission and 60 (5{\%}) died within 30 days. For the composite outcome, a model containing clinical variables alone had an area under the receiver-operating characteristic curve (AUC) of 0.68 [95{\%} CI 0.64-0.72]. Adding marital status, support from family and measures of physical frailty increased the AUC (p <0.05) to 0.70 [95{\%} CI 0.66-0.74].Conclusions: Measures of physical frailty and social support improve prediction of 30-day outcome after an admission for HF but predicting near-term events remains imperfect. Further external validation and improvement of the model is required. (c) 2018 Elsevier B. V. All rights reserved.",
keywords = "30-day re-admission, ANXIETY, DEPRESSION, DIAGNOSIS, DISEASE, Frailty, GO, Heart failure, MODELS, MORTALITY, Mortality, Psychosocial factors, READMISSION",
author = "I Sokoreli and Cleland, {J G} and Pauws, {S C} and Steyerberg, {E W} and {de Vries}, {J J G} and Riistama, {J M} and K Dobbs and J Bulemfu and Clark, {A L}",
note = "Copyright {\circledC} 2018 Elsevier B.V. All rights reserved.",
year = "2019",
month = "3",
day = "1",
doi = "10.1016/j.ijcard.2018.12.030",
language = "English",
volume = "278",
pages = "167--172",
journal = "International Journal of Cardiology",
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Added value of frailty and social support in predicting risk of 30-day unplanned re-admission or death for patients with heart failure : An analysis from OPERA-HF. / Sokoreli, I; Cleland, J G; Pauws, S C; Steyerberg, E W; de Vries, J J G; Riistama, J M; Dobbs, K; Bulemfu, J; Clark, A L.

In: International Journal of Cardiology, Vol. 278, 01.03.2019, p. 167-172.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Added value of frailty and social support in predicting risk of 30-day unplanned re-admission or death for patients with heart failure

T2 - An analysis from OPERA-HF

AU - Sokoreli, I

AU - Cleland, J G

AU - Pauws, S C

AU - Steyerberg, E W

AU - de Vries, J J G

AU - Riistama, J M

AU - Dobbs, K

AU - Bulemfu, J

AU - Clark, A L

N1 - Copyright © 2018 Elsevier B.V. All rights reserved.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: Models for predicting the outcome of patients hospitalized for heart failure (HF) rarely take a holistic view. We assessed the ability ofmeasures of frailty and social support in addition to demographic, clinical, imaging and laboratory variables to predict short-term outcome for patients discharged after a hospitalization for HF.Methods: OPERA-HF is a prospective observational cohort, enrolling patients hospitalized for HF in a single center in Hull, UK. Variables were combined in a logistic regression model after multiple imputation of missing data to predict the composite outcome of death or readmission at 30 days. Comparisons were made to a model using clinical variables alone. The discriminative performance of each model was internally validated with bootstrap re-sampling.Results: 1094 patients were included (mean age 77 [interquartile range 68-83] years; 40% women; 56% with moderate to severe left ventricular systolic dysfunction) of whom 213 (19%) had an unplanned re-admission and 60 (5%) died within 30 days. For the composite outcome, a model containing clinical variables alone had an area under the receiver-operating characteristic curve (AUC) of 0.68 [95% CI 0.64-0.72]. Adding marital status, support from family and measures of physical frailty increased the AUC (p <0.05) to 0.70 [95% CI 0.66-0.74].Conclusions: Measures of physical frailty and social support improve prediction of 30-day outcome after an admission for HF but predicting near-term events remains imperfect. Further external validation and improvement of the model is required. (c) 2018 Elsevier B. V. All rights reserved.

AB - Background: Models for predicting the outcome of patients hospitalized for heart failure (HF) rarely take a holistic view. We assessed the ability ofmeasures of frailty and social support in addition to demographic, clinical, imaging and laboratory variables to predict short-term outcome for patients discharged after a hospitalization for HF.Methods: OPERA-HF is a prospective observational cohort, enrolling patients hospitalized for HF in a single center in Hull, UK. Variables were combined in a logistic regression model after multiple imputation of missing data to predict the composite outcome of death or readmission at 30 days. Comparisons were made to a model using clinical variables alone. The discriminative performance of each model was internally validated with bootstrap re-sampling.Results: 1094 patients were included (mean age 77 [interquartile range 68-83] years; 40% women; 56% with moderate to severe left ventricular systolic dysfunction) of whom 213 (19%) had an unplanned re-admission and 60 (5%) died within 30 days. For the composite outcome, a model containing clinical variables alone had an area under the receiver-operating characteristic curve (AUC) of 0.68 [95% CI 0.64-0.72]. Adding marital status, support from family and measures of physical frailty increased the AUC (p <0.05) to 0.70 [95% CI 0.66-0.74].Conclusions: Measures of physical frailty and social support improve prediction of 30-day outcome after an admission for HF but predicting near-term events remains imperfect. Further external validation and improvement of the model is required. (c) 2018 Elsevier B. V. All rights reserved.

KW - 30-day re-admission

KW - ANXIETY

KW - DEPRESSION

KW - DIAGNOSIS

KW - DISEASE

KW - Frailty

KW - GO

KW - Heart failure

KW - MODELS

KW - MORTALITY

KW - Mortality

KW - Psychosocial factors

KW - READMISSION

U2 - 10.1016/j.ijcard.2018.12.030

DO - 10.1016/j.ijcard.2018.12.030

M3 - Article

VL - 278

SP - 167

EP - 172

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -