Readmission after hospitalization for heart failure among patients with chronic kidney disease: a prediction model.

Robert M. Perkins, Amir Rahman, Ion D. Bucaloiu, Evan Norfolk, William DiFilippo, James E. Hartle, H. Lester Kirchner

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

30-day readmission rates after hospitalization for heart failure (HF) approach 25%, and patients with chronic kidney disease (CKD) are disproportionately represented. A retrospective cohort study was conducted to develop a prediction tool for 30-day readmission after hospitalization for HF among those with non-dialysis dependent CKD. Geisinger primary care patients with Stage 3 - 5 CKD hospitalized with a primary discharge diagnosis of HF during the period July 1, 2004 through February 28, 2010 were eligible. Multivariate logistic regression was employed to build models from predictors of 30-day readmission, drawn from demographic, clinical, laboratory, and pharmaceutical variables in the electronic health record. Variables were manually removed to achieve a model with satisfactory goodness-of-fit and parsimony while maximizing area under the receiver operating characteristic curve (AUC). Internal validation was performed using the bootstrap resampling method (1,000 samples) to provide a bias-corrected AUC. 607 patients with CKD were admitted for HF during the study period; 116 (19.1%) were readmitted within 30 days. A model incorporating 23 variables across domains of medical history, active outpatient pharmaceuticals, vital signs, laboratory tests, and recent inpatient and outpatient resource utilization yielded an AUC (95% CI) of 0.792 (0.746 - 0.838). The bias-corrected AUC was 0.743. At an estimated readmission probability of 20%, the model correctly classified readmission status for 73% of the population, with a sensitivity of 69% and a specificity of 73%. A robust electronic health record may facilitate the identification of CKD patients at risk for readmission after hospitalization for HF.

Original languageEnglish (US)
Pages (from-to)433-440
Number of pages8
JournalClinical nephrology
Volume80
Issue number6
StatePublished - Dec 1 2013

ASJC Scopus subject areas

  • Nephrology

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    Perkins, R. M., Rahman, A., Bucaloiu, I. D., Norfolk, E., DiFilippo, W., Hartle, J. E., & Kirchner, H. L. (2013). Readmission after hospitalization for heart failure among patients with chronic kidney disease: a prediction model. Clinical nephrology, 80(6), 433-440.