Establishment And Application Of Risk Prediction Model For Unplanned Readmission In Patients With Chronic Heart Failure

ObjectiveTo investigate the occurrence of unplanned readmission of patients with chronic heart failure in the department of cardiovascular medicine in a tertiary A hospital within 6 months after discharge;Identify the risk factors of unplanned readmission of patients with chronic heart failure within 6 months after discharge;Build and validate the risk prediction model of unplanned readmission of patients with chronic heart failure within 6 months after discharge,and provide accurate and efficient risk prediction tools for clinical medical staff.Based on the risk prediction model,combined with the IKAP theory,the characteristics of chronic heart failure disease,and the opinions of cardiovascular experts,a nursing intervention plan for unplanned readmission of patients with chronic heart failure was formed and applied to reduce the occurrence of unplanned readmission and other adverse outcomes of patients with chronic heart failure.Methods1.Based on the review of Chinese and English literature and the opinions of experts in the field of heart failure,the demographic questionnaire of patients with chronic heart failure and the impact factor questionnaire of unplanned readmission was designed.Collect data such as social demography,clinical disease,disease-related score,and laboratory examination of patients with chronic heart failure.908 patients with chronic heart failure who were hospitalized in the Department of Cardiology of a Class III hospital from January 2020 to March 2021 were selected as the subjects of model construction and validation.Among them,712 patients hospitalized from January 2020 to December 2020 were randomly divided into modeling group(n=498)and internal validation group(n=214)according to the ratio of 7:3;196 patients hospitalized from January 2021 to March 2021 were taken as the external validation group.2.According to the relevant clinical data of patients and the follow-up results of6 months after discharge,single factor analysis was used to screen the influencing factors of patients’ unplanned readmission;Multivariate analysis was carried out by using backward stepwise deletion binary logistic regression to explore the independent risk factors of unplanned readmission of patients,and the risk prediction model of unplanned readmission of patients with chronic heart failure was constructed six months after discharge;The internal and external validation of the model is carried out by using discriminant analysis to test the prediction effect of the model.3.It is convenient to select 120 patients with chronic heart failure who were hospitalized in the Department of Cardiology of a third-class A hospital from June2021 to September 2021 as the study subjects,and divide them into the experimental group and the control group by stratified random method.All patients participated in routine nursing management,and the high-risk patients in the experimental group implemented nursing intervention plans based on IKAP theory and model results.Use Kaplan Meier survival analysis to compare the occurrence of unplanned readmission within 6 months after discharge between two groups of study subjects.Use tests and non parametric tests to compare the albumin levels,anemia status,self-care level,and quality of life of the two groups of patients.Results1.The incidence of unplanned readmission of patients with chronic heart failure is high.A total of 908 patients with heart failure were included in this study.Among them,286 patients with heart failure,had unplanned readmission within 6 months after discharge,with an unplanned readmission rate of about 31.50%.The results of univariate analysis showed that there was no significant difference between the two groups in gender,hypertension,diabetes,atrial fibrillation,hyperlipidemia,hyponatremia,heart rate,C-reactive protein,HFKT score,self-efficacy score,depression,bad eating habits,smoking and drinking(all P>0.05).There were statistically significant differences between the two groups in age,education,coronary heart disease,anemia,CCI score,cardiac function grading,B-type natriuretic peptide(BNP),serum creatinine,glomerular filtration rate,uric acid,urea nitrogen,albumin,SCHFI score,compliance score,and self-care ability score(P<0.05).Multivariate logistic regression analysis showed that albumin(OR=2.489),anemia(OR=3.479),uric acid(OR=2.524),B-type natriuretic peptide(OR=1.765),CCI score of 3-5(OR=2.897),CCI score of 6-7(OR=7.199),moderate dependence on self-care ability(OR=6.371),and severe dependence on self-care ability(OR=67.186)were predictive factors of unplanned readmission of patients with chronic heart failure within 6months after discharge.2.The risk prediction model for unplanned readmission of patients with chronic heart failure is: P=1/{1+exp [-(0.912 × Albumin+1.247 × Anemia+0.926 ×Uric acid+0.568 × B-type natriuretic peptide+1.064 × CCI score 3-5+1.974 ×CCI score 6-7+1.852 × Moderate dependence on self-care ability+4.207 × Heavy dependence on self-care ability-6.688)]}.When the score of the risk prediction model is ≥ 0.206,patients with chronic heart failure are high probability to have unplanned readmission.3.The result of the Homer-Lemshaw(H-L)test of the model was P=0.635,and the difference was not statistically significant(P>0.05),indicating that the model fitted well;The AUC was 0.903,95% CI(0.876,0.930),P<0.001;The maximum value of the Jordan index of the model is 0.633,the optimal critical value is 0.206,the sensitivity is 91.8%,and the specificity is 81.5%,indicating that the model has strong prediction and identification ability.The internal validation accuracy rate of the model is 81.8%,the error rate is 18.2%,the sensitivity is 83.1%,and the specificity is 81.1%;The accuracy rate of external verification is 83.7%,the error rate is 16.3%,the sensitivity is 80.7%,and the specificity is 84.9%.4.The unplanned readmission of patients in the test group was better than that in the control group(P<0.05);The albumin level of patients in the test group was significantly higher than that in the control group(P<0.05);The anemia status of patients in the test group was significantly better than that in the control group(P<0.05);The level of self-care ability of patients in the test group was significantly higher than that in the control group(P<0.05);The quality of life of patients in the test group was significantly better than that in the control group(P<0.05).ConclusionsThe readmission rate of patients with chronic heart failure is high,and many independent risk factors affect the unplanned readmission of patients with heart failure within 6 months.The prediction model for the risk of unplanned readmission of patients with chronic heart failure has good prediction efficiency,good fitting and differentiation,and has certain reference significance for early identification of high-risk groups of unplanned readmission of patients with chronic heart failure.The nursing intervention program based on the results of risk prediction model and IKAP theory can significantly improve the patients’ unplanned readmission,nutritional status,self-care level,and quality of life,and provide certain reference value for clinical nursing intervention of such diseases.