Prognostic Study Of Out Of Hospital Management Based On Patient-Reported Outcomes In Patients With Chronic Heart Failure

Objective:To investigate whether long-term out of hospital follow-up based on patient reported outcome(PRO)can improve the prognosis of patients with chronic heart failure(CHF).By comparing the readmission rate and mortality between the follow-up group and the control group,the influencing factors of the prognosis of patients with CHF after out of hospital follow-up were analyzed.the prediction model of rehospitalization was established to provide an effective way for out of hospital management of patients with heart failure.Methods:From May 2017 to January 2020,CHF patients hospitalized in the first hospital of Shanxi Medical University,Shanxi cardiovascular disease hospital and Bethune hospital were selected to collect baseline data during hospitalization.The patients were followed up by telephone one month,three months,six months and 12 months after discharge,and then every six months.In the part one: patients with CHF from May 2017 to May 2019 were divided into follow-up group(n = 290)and control group(n = 183)according to whether they received PRO follow-up.Chi square test was used to compare the cardiac readmission rate and cardiovascular mortality between the two groups,t test was used to compare the quality of life score,and multivariate Cox regression was used to analyze the influencing factors of prognosis.In the part two: using a PROM as a measurement tool,we conducted a readmission nomogram for chronic heart failure on the study comprising of454 patients with chronic heart failure hospitalized between May 2017 to January 2020.A Concordance index and calibration curve were used to evaluate the discriminative ability and predictive accuracy of the nomogram.A bootstrap resampling method was used for internal validation of results.Results:In the part one: the cardiovascular mortality in the follow-up group was statistically lower than that in the control group(P<0.05),and the PRO score was statistically higher than that in the control group(P < 0.05).The heart failure rehospitalization rate in the follow-up group was lower than that in the control group,which was not statistically significant(P>0.05).Multivariate Cox regression showed that high physiological score,moderate alcohol consumption and high BMI were protective factors for CHF patients with heart failure to be rehospitalized during follow-up;Smoking,high score of psychological field and increased creatinine concentration were the risk factors for CHF patients to be rehospitalized;high physiological score and increased follow-up were the protective factors for cardiovascular death in CHF patients during follow-up.High psychological score,long duration of disease,and increased creatinine concentration were risk factors for cardiovascular death in CHF patients during follow-up.In the part two: the result of Cox regression analysis showed,the gender,income,health care,appetite-sleep,anxiety,depression,paranoia,support,and independence were identified and included in the nomogram.The nomogram showed moderate discrimination,with a concordance index of 0.737(95% CI 0.673–0.800).The calibration curves for the probability of readmission for patients with chronic heart failure showed high consistency between the predicted probability and the actual probability.Conclusions:Long term follow-up management of CHF patients can improve the quality of life and reduce the mortality of heart failure.The rehospitalization prediction model can evaluate the risk of rehospitalization of CHF patients,and can assist clinicians with personalized treatment recommendations.