Improved 30 day heart failure rehospitalization prediction through the addition of device-measured parameters

• Type of Material: Article
• Authors: Jason R. Brown, Medtron PLC.; Alvaro Alonso, Emory University; Sula Mazimba, University of Virginia Health System; Eduardo N. Warman, Medtron PLC.; Kenneth C. Bilchick, University of Virginia Health System
• Language: English
• Date: 2020-09-13
• Publisher: WILEY PERIODICALS, INC
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/ehf2.12956
• Title of Journal or Parent Work: ESC HEART FAILURE
• Volume: 7
• Issue: 6
• Start Page: 3762
• End Page: 3771
• Grant/Funding Information: Dr. Bilchick's work on this project was supported by National Institutes of Health grants R56 HL135556 and R03 HL135463. Dr. Alonso is supported by National Institutes of Health grants R01 HL122200, K24 HL148521, and R21 AG058445 and American Heart Association grant 16EIA26410001.
• Keywords: HOSPITALIZATIONS; Life Sciences & Biomedicine; Cardiac resynchronization therapy; Cardiac & Cardiovascular Systems; Risk stratification; INTRATHORACIC IMPEDANCE; STATEMENT; RISK; READMISSION; Science & Technology; CARDIAC RESYNCHRONIZATION THERAPY; Heart failure; PERFORMANCE; MORTALITY; Rehospitalization; Cardiovascular System & Cardiology; LIMITATIONS; Registry
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery; Engineering, Biomedical

Abstract

Aims: This study aimed to improve in-person clinical evaluation on the day of heart failure (HF) hospitalization discharge by adding device-measured parameters to predict 30 day HF rehospitalization risk in cardiac resynchronization therapy-defibrillator (CRT-D) patients. Methods and results: In a cohort of Medicare patients with CRT-Ds, the independent prognostic value of four device-measured parameters was assessed relative to typical clinical parameters associated with rehospitalization risk. Medicare registry, claims, and Medtronic CareLink® Network data for these patients were analysed using logistic regression modelling and net reclassification methods. Among 1563 CRT-D patients, 411 patients had 607 HF hospitalization events during a median 6.3 years of follow-up. Compared with clinical variables alone, impedance measurements resulted in a 28% improvement between the predicted probabilities of having vs. not having a 30 day HF rehospitalization (relative integrated discrimination improvement = 0.28) and a net 42% improvement in the classification of 30 day HF rehospitalization events and non-events after an index HF hospitalization (net reclassification index = 0.42; 95% CI: 0.10, 0.74). Conclusions: In CRT patients, intrathoracic impedance measurements improve prediction of 30 day HF rehospitalization over clinical characteristics alone. The present study provides supportive data for the routine evaluation of intrathoracic impedance prior to discharge in patient with CRT devices. Furthermore, the models developed in this study could be used to design interventions to improve compliance with Medicare reimbursement guidelines regarding 30 day HF rehospitalization.