Implantable device diagnostics on day of discharge identify heart failure patients at increased risk for early readmission for heart failure. (28th December 2013)

• Record Type: Journal Article
• Authors: Small, Roy S.; Whellan, David J.; Boyle, Andrew; Sarkar, Shantanu; Koehler, Jodi; Warman, Eduardo N.; Abraham, William T.
• Is Part Of: European journal of heart failure. Volume 16:Number 4(2014)
• Page Start: 419
• Page End: 425
• Publication Date: 2013-12-28
• Subjects: Heart failure -- Implantable device diagnostics -- Early readmission risk; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.48
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract : Aims: We hypothesized that diagnostic data in implantable devices evaluated on the day of discharge from a heart failure hospitalization (HFH) can identify patients at risk for HF readmission (HFR) within 30 days. Methods and results: In this retrospective analysis of four studies enrolling patients with CRT devices, we identified patients with a HFH, device data on the day of discharge, and 30‐day post‐discharge clinical follow‐up. Four diagnostic criteria were evaluated on the discharge day: (i) intrathoracic impedance >8 Ω below reference impedance; (ii) AF burden >6 h; (iii) CRT pacing <90%; and (iv) night heart rate >80 b.p.m. Patients were considered to have higher risk for HFR if ≥2 criteria were met, average risk if 1 criterion was met, and lower risk if no criteria were met. A Cox proportional hazards model was used to compare the groups. The data cohort consisted of a total of 265 HFHs in 175 patients, of which 36 (14%) were followed by HFR. On the discharge day, ≥2 criteria were met in 43 (16% of 265 HFHs), only 1 criterion was met in 92 (35%), and none of the four criteria were met in 130 HFHs (49%); HFR rates were 28, 16, and 7%, respectively. HFH with ≥2 criteria met was five times more likely to have HFR compared with HFH with no criteria met (adjusted hazard ratio 5.0; 95% confidence interval 1.9–13.5, P = 0.001). Conclusion: Device‐derived diagnostic criteria evaluated on the day of discharge identified patients at significantly higher risk of HFR.