Riester et al reported the ToPP-HF score for predicting 30-day readmission for a patient with heart failure. This can help to identify a patient who may benefit from more aggressive management. The authors are from Brown University and Rhode Island Hospital.
ToPP-HF is based on Tool, Pharmacists, Predict, Heart Failure.
Parameters:
(1) number of previous hospital admissions in past 6 months
(2) primary admission diagnosis (for this admission)
(3) number of scheduled medications on discharge (excluding PRN medications)
(4) number of comorbidities
(5) diagnosis of COPD
(6) eGFR on hospital admission in mL per min per 1.73 square meters
(7) hospital admission length of stay in days
(8) left ventricular ejection fraction in percent at discharge
(9) any critical care during this admission
(10) prescribed ACEI, ARB or ARNI on hospital discharge
(11) prescribed antiarrhythmic drug on hospital discharge
(12) serum potassium on hospital discharge
(13) serum sodium on hospital discharge
|
Parameter |
Finding |
Poitns |
|
previous admissions |
0 |
0 |
|
|
1 |
5 |
|
|
>= 2 |
11 |
|
primary admission dx |
heart failure |
-4 |
|
|
other |
0 |
|
scheduled meds |
<= 8 |
0 |
|
|
9 to 13 |
4 |
|
|
>= 14 |
7 |
|
comorbidities |
<= 7 |
0 |
|
|
8 to 10 |
2 |
|
|
>= 11 |
4 |
|
COPD |
no |
0 |
|
|
yes |
3 |
|
eGFR |
>= 60 |
-10 |
|
|
45 to 59 |
-5 |
|
|
30 to 44 |
-2 |
|
|
< 30 |
0 |
|
length of stay |
<= 3 days |
0 |
|
|
4 to 5 days |
3 |
|
|
6 to 8 days |
2 |
|
|
>= 9 days |
5 |
|
LVEF |
>= 50 percent |
-1 |
|
|
40 to 49 percent |
8 |
|
|
<= 39 |
0 |
|
critical care |
no |
0 |
|
|
yes |
5 |
|
ACEI, ARB or ARNI |
no |
0 |
|
|
yes |
-2 |
|
antiarrhythmic drug |
no |
0 |
|
|
yes |
-9 |
|
serum potassium |
>= 3.5 mmol/L |
0 |
|
|
< 3.5 mmol/L |
6 |
|
serum sodium |
< 135 mmol/L |
0 |
|
|
>= 135 mmol/L |
-4 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -30
• maximum score: 49
|
Score |
Risk of Readmission |
Rate of Readmission |
|
< 0 |
low |
9% |
|
0 to 11 |
moderate |
18% |
|
12 to 16 |
moderate to high |
24% |
|
> 16 |
high |
32% |
Performance:
• The area under the ROC curve is 0.69.
