Comparative performance of risk prediction indices for mortality or readmission following heart failure hospitalization

Tauben Averbuch; Ali Zafari; Shofiqul Islam; Shun Fu Lee; Rajiv Sankaranarayanan; Stephen J Greene; Mamas A Mamas; Ambarish Pandey; Harriette Gc Van Spall

doi:10.1002/ehf2.15129

Comparative performance of risk prediction indices for mortality or readmission following heart failure hospitalization

ESC Heart Fail. 2025 Jan 21. doi: 10.1002/ehf2.15129. Online ahead of print.

Authors

Tauben Averbuch¹, Ali Zafari², Shofiqul Islam³, Shun Fu Lee³, Rajiv Sankaranarayanan^{4

5}, Stephen J Greene⁶, Mamas A Mamas⁷, Ambarish Pandey⁸, Harriette Gc Van Spall^{3

9

10}

Affiliations

¹ Department of Cardiology, University of Calgary, Calgary, AB, Canada.
² Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
³ Population Health Research Institute, Hamilton, ON, Canada.
⁴ Department of Cardiology, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
⁵ Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, UK.
⁶ Duke Clinical Research Institute, Durham, North Carolina, USA.
⁷ Keele University, Keele, UK.
⁸ Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁹ Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

PMID: 39835342
DOI: 10.1002/ehf2.15129

Abstract

Aims: Risk prediction indices used in worsening heart failure (HF) vary in complexity, performance, and the type of datasets in which they were validated. We compared the performance of seven risk prediction indices in a contemporary cohort of patients hospitalized for HF.

Methods and results: We assessed the performance of the Length of stay and number of Emergency department visits in the prior 6 months (LE), Length of stay, number of Emergency department visits in the prior 6 months, and admission N-Terminal prohormone of brain natriuretic peptide (NT-proBNP (LENT), Length of stay, Acuity, Charlson co-morbidity index, and number of Emergency department visits in the prior 6 months (LACE), Get With The Guidelines Heart Failure (GWTG), Readmission Risk Score (RRS), Enhanced Feedback for Effective Cardiac Treatment model (EFFECT), and Acute Decompensated Heart Failure National Registry (ADHERE) risk indices among consecutive patients hospitalized for HF and discharged alive from January 2017 to December 2019 in a network of hospitals in England. The primary composite outcome was 30-day all-cause mortality or readmission. We assessed model discrimination and overall accuracy using the C-statistic (higher values, better) and Brier score (lower values, better), respectively. Among 1206 patients in the cohort, 45.0% were female, mean (SD) age was 76.6 (11.7) years, and mean (SD) left ventricular ejection fraction was 43.0% (11.6). At 30 days, 236 (19.6%) patients were readmitted and 28 (2.3%) patients died, with 264 (21.9%) patients experiencing either readmission or death. The LENT index offered the combination of greatest risk discrimination and accuracy for the primary composite outcome (C-statistic: 0.97; 95% CI 0.96, 0.98; 0.29; Brier score: 0.05). The LE (C-statistic: 0.95; 95% CI 0.93, 0.96; Brier score: 0.06) and LACE (C-statistic: 0.90; 95% CI 0.88, 0.92; Brier score 0.09) indices had high discrimination and accuracy. Discrimination and accuracy were modest with the RRS (C-statistic: 0.65; 95% CI 0.61, 0.69; Brier score: 0.16) and EFFECT (C-statistic: 0.64; 95% CI 0.60, 0.67; Brier score: 0.16) score; and poor with the GWTG-HF (C-statistic: 0.62; 95% CI 0.58, 0.66; Brier score: 0.17) and ADHERE (C-statistic: 0.54; 95% CI 0.50, 0.57; Brier score: 0.17) scores.

Conclusions: In a study that compared the performance of seven risk prediction indices in a contemporary cohort of patients hospitalized for HF, the simple LENT index offered the greatest combination of discrimination and accuracy for the primary composite outcome of 30-day all-cause mortality or readmission. This three-variable index -using length of hospital stay, preceding emergency department visits and admission NT-proBNP level- is a practical and reliable way to assess prognosis following hospitalization for HF.

Keywords: 30‐day mortality; 30‐day readmission; Acute heart failure; Risk prediction.

Abstract

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