Validated, electronic health record deployable prediction models for assessing patient risk of 30-day rehospitalization and mortality in older heart failure patients

JACC Heart Fail. 2013 Jun;1(3):245-51. doi: 10.1016/j.jchf.2013.01.008. Epub 2013 Jun 3.


Objectives: The study sought to derive and validate risk-prediction tools from a large nationwide registry linked with Medicare claims data.

Background: Few clinical models have been developed utilizing data elements readily available in electronic health records (EHRs) to facilitate "real-time" risk estimation.

Methods: Heart failure (HF) patients ≥ 65 years of age hospitalized in the GWTG-HF (Get With The Guidelines-Heart Failure) program were linked with Medicare claims from January 2005 to December 2009. Multivariable models were developed for 30-day mortality after admission, 30-day rehospitalization after discharge, and 30-day mortality/rehospitalization after discharge. Candidate variables were selected based on availability in EHRs and prognostic value. The models were validated in a 30% random sample and separately in patients with reduced and preserved ejection fraction (EF).

Results: Among 33,349 patients at 160 hospitals, 3,002 (9.1%) died within 30 days of admission, 7,020 (22.8%) were rehospitalized within 30 days of discharge, and 8,374 (27.2%) died or were rehospitalized within 30 days of discharge. Compared with patients classified as low risk, high-risk patients had significantly higher odds of death (odds ratio [OR]: 8.82, 95% confidence interval [CI]: 7.58 to 10.26), rehospitalization (OR: 1.99, 95% CI: 1.86 to 2.13), and death/rehospitalization (OR: 2.65, 95% CI: 2.44 to 2.89). The 30-day mortality model demonstrated good discrimination (c-index 0.75) while the rehospitalization and death/rehospitalization models demonstrated more modest discrimination (c-indices of 0.59 and 0.62), with similar performance in the validation cohort and for patients with preserved and reduced EF.

Conclusions: These predictive models allow for risk stratification of 30-day outcomes for patients hospitalized with HF and may provide a validated, point-of-care tool for clinical decision making.

Keywords: electronic health records; heart failure; predictive models; risk stratification.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Electronic Health Records*
  • Female
  • Heart Failure / mortality*
  • Humans
  • Male
  • Models, Theoretical*
  • Patient Readmission / statistics & numerical data*
  • Prognosis
  • Risk Assessment
  • Time Factors