Evaluating the potential of the outcome-oriented nursing assessment for acute care (ePA–AC) to identify cardiovascular patients at risk for unplanned 30- and 180-day all-cause readmission: Development and validation of a routine data-based model

Abstract

Background

Rehospitalisation rates in patients with cardiovascular diseases are high. Routine data — including nursing data — might help identify patients at risk.

Objective

To evaluate the potential predictive value of routinely collected inpatient data and nursing assessment (ePA–AC) scores to identify cardiovascular inpatients at risk of unplanned 30- and 180-day all-cause rehospitalisation.

Methods

This retrospective cohort study included patients hospitalised ≥48 h in the cardiology department from December 2012 – June 2022. The sample was divided into derivation and validation sets based on time of first hospitalisation. Logistic regression and multiple Cox proportional hazards regression analyses were applied.

Results

The derivation dataset included 6049 patients, the validation set 1005. Of these 7054 patients, 505 (7.2 %) experienced unplanned all-cause rehospitalisation within 30 days and 1186 (16.81 %) within 180 days post-discharge. The ROC's area under the curve (AUC) values for the 30-day logistic regression model and 180-day Cox regression model were respectively 0.61 and 0.65. Both models identified two key risk factors: ≥1 emergency department visit in the past year (OR 1.49, 95 % CI 1.18–1.86, HR 1.74, 95 % CI 1.52–2.00); and use of coumarin (OR 1.47, 95 %-CI 1.12–1.90, HR 1.27, 95 % CI 1.08–1.50). From the ePA–AC, chronic pain (HR 1.48, 95 %-CI 1.14–1.91) and acute breathing problems (HR 1.41, 95 %-CI 1.03–1.94) were risk factors for 180-day but not 30-day rehospitalisation.

Conclusion

Both models demonstrated low to moderate predictive value. From the ePA–AC variables, only pain and breathing problems were predictive for unplanned all-cause 180-day rehospitalisations.