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Joint Impact of Clinical and Behavioral Variables on the Risk of Unplanned Readmission and Death after a Heart Failure Hospitalization

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  • Badri Padhukasahasram
  • Chandan K Reddy
  • Yan Li
  • David E Lanfear

Abstract

Most current methods for modeling rehospitalization events in heart failure patients make use of only clinical and medications data that is available in the electronic health records. However, information about patient-reported functional limitations, behavioral variables and socio-economic background of patients may also play an important role in predicting the risk of readmission in heart failure patients. We developed methods for predicting the risk of rehospitalization in heart failure patients using models that integrate clinical characteristics with patient-reported functional limitations, behavioral and socio-economic characteristics. Our goal was to estimate the predictive accuracy of the joint model and compare it with models that make use of clinical data alone or behavioral and socio-economic characteristics alone, using real patient data. We collected data about the occurrence of hospital readmissions from a cohort of 789 heart failure patients for whom a range of clinical and behavioral characteristics data is also available. We applied the Cox model, four different variants of the Cox proportional hazards framework as well as an alternative non-parametric approach and determined the predictive accuracy for different categories of variables. The concordance index obtained from the joint prediction model including all types of variables was significantly higher than the accuracy obtained from using only clinical factors or using only behavioral, socioeconomic background and functional limitations in patients as predictors. Collecting information on behavior, patient-reported estimates of physical limitations and frailty and socio-economic data has significant value in the predicting the risk of readmissions with regards to heart failure events and can lead to substantially more accurate events prediction models.

Suggested Citation

  • Badri Padhukasahasram & Chandan K Reddy & Yan Li & David E Lanfear, 2015. "Joint Impact of Clinical and Behavioral Variables on the Risk of Unplanned Readmission and Death after a Heart Failure Hospitalization," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-11, June.
    • Handle: RePEc:plo:pone00:0129553
    DOI: 10.1371/journal.pone.0129553
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    References listed on IDEAS

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    1. Chris Hans, 2009. "Bayesian lasso regression," Biometrika, Biometrika Trust, vol. 96(4), pages 835-845.
    2. Hao Helen Zhang & Wenbin Lu, 2007. "Adaptive Lasso for Cox's proportional hazards model," Biometrika, Biometrika Trust, vol. 94(3), pages 691-703.
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    Cited by:

    1. Claire M Duflos & Kamila Solecki & Laurence Papinaud & Vera Georgescu & François Roubille & Gregoire Mercier, 2016. "The Intensity of Primary Care for Heart Failure Patients: A Determinant of Readmissions? The CarPaths Study: A French Region-Wide Analysis," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-13, October.

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