TY - JOUR
T1 - Development and validation of an acute heart failure-specific mortality predictive model based on administrative data
AU - Sasaki, Noriko
AU - Lee, Jason
AU - Park, Sungchul
AU - Umegaki, Takeshi
AU - Kunisawa, Susumu
AU - Otsubo, Tetsuya
AU - Ikai, Hiroshi
AU - Imanaka, Yuichi
N1 - Funding Information:
The research reported here was supported in part by a Health Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan, and a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science.
PY - 2013/9
Y1 - 2013/9
N2 - Background: Acute heart failure (AHF) with its high in-hospital mortality is an increasing burden on healthcare systems worldwide, and comparing hospital performance is required for improving hospital management efficiency. However, it is difficult to distinguish patient severity from individual hospital care effects. The aim of this study was to develop a risk adjustment model to predict in-hospital mortality for AHF using routinely available administrative data. Methods: Administrative data were extracted from 86 acute care hospitals in Japan. We identified 8620 hospitalized patients with AHF from April 2010 to March 2011. Multivariable logistic regression analyses were conducted to analyze various patient factors that might affect mortality. Two predictive models (models 1 and 2; without and with New York Heart Association functional class, respectively) were developed and bootstrapping was used for internal validation. Expected mortality rates were then calculated for each hospital by applying model2. Results: The overall in-hospital mortality rate was 7.1%. Factors independently associated with higher in-hospital mortality included advanced age, New York Heart Association class, and severe respiratory failure. In contrast, comorbid hypertension, ischemic heart disease, and atrial fibrillation/flutter were found to be associated with lower in-hospital mortality. Both model 1 and model 2 demonstrated good discrimination with c-statistics of 0.76 (95% confidence interval, 0.74-0.78) and 0.80 (95% confidence interval, 0.78-0.82), respectively, and good calibration after bootstrap correction, with better results in model2. Conclusions: Factors identifiable from administrative data were able to accurately predict in-hospital mortality. Application of our model might facilitate risk adjustment for AHF and can contribute to hospital evaluations.
AB - Background: Acute heart failure (AHF) with its high in-hospital mortality is an increasing burden on healthcare systems worldwide, and comparing hospital performance is required for improving hospital management efficiency. However, it is difficult to distinguish patient severity from individual hospital care effects. The aim of this study was to develop a risk adjustment model to predict in-hospital mortality for AHF using routinely available administrative data. Methods: Administrative data were extracted from 86 acute care hospitals in Japan. We identified 8620 hospitalized patients with AHF from April 2010 to March 2011. Multivariable logistic regression analyses were conducted to analyze various patient factors that might affect mortality. Two predictive models (models 1 and 2; without and with New York Heart Association functional class, respectively) were developed and bootstrapping was used for internal validation. Expected mortality rates were then calculated for each hospital by applying model2. Results: The overall in-hospital mortality rate was 7.1%. Factors independently associated with higher in-hospital mortality included advanced age, New York Heart Association class, and severe respiratory failure. In contrast, comorbid hypertension, ischemic heart disease, and atrial fibrillation/flutter were found to be associated with lower in-hospital mortality. Both model 1 and model 2 demonstrated good discrimination with c-statistics of 0.76 (95% confidence interval, 0.74-0.78) and 0.80 (95% confidence interval, 0.78-0.82), respectively, and good calibration after bootstrap correction, with better results in model2. Conclusions: Factors identifiable from administrative data were able to accurately predict in-hospital mortality. Application of our model might facilitate risk adjustment for AHF and can contribute to hospital evaluations.
UR - http://www.scopus.com/inward/record.url?scp=84882815543&partnerID=8YFLogxK
U2 - 10.1016/j.cjca.2012.11.021
DO - 10.1016/j.cjca.2012.11.021
M3 - Article
C2 - 23395282
AN - SCOPUS:84882815543
SN - 0828-282X
VL - 29
SP - 1055
EP - 1061
JO - Canadian Journal of Cardiology
JF - Canadian Journal of Cardiology
IS - 9
ER -