288 - High LACE Score with Abnormal Mini-Cog is a Strong Predictive Tool for All-Cause 30-Day Readmissions in Heart Failure Patients

Abstract

Background: The Length of Stay, Acuity, Comorbidity, and Emergency Department use (LACE) index is used to predict unplanned 30-day readmissions among patients with all-cause hospitalizations. There is conflicting data on the predictive ability of the LACE index in patients admitted with heart failure (HF). Furthermore, there is a lack of data on the usefulness of this index in HF patients with cognitive impairment (CI) that are admitted with HF exacerbations. The goal of this study to investigate whether the LACE index predicts 30-day readmissions in all patients with HF, and secondarily, in those with HF and CI. Methods: We retrospectively assessed 97 patients (age 65 years and older) admitted with HF in our institution from August 2016 to February 2017. Patients were stratified into high LACE (score > = 10) and low LACE (<10) groups. Presence of CI was assessed on admission using the Mini-Cog tool, with a score of < 3 used to indicate presence of CI. Our primary outcome was all-cause 30-day readmissions in the overall cohort and in a sub-group of patients with cognitive impairment. Results: Our cohort had a mean age of 78 years, 54% were female, 63% were Caucasian, and 59% had heart failure with reduced ejection fraction (EF). The majority of patients (92%) had high LACE scores. Patients with high LACE scores (n = 89) were slightly older (78.2 ± 8.3 years vs 77.0 ± 7.3 years, P = .69). 22 patients (23%) had all-cause readmissions within 30 days of discharge. Overall, mean LACE score was slightly higher in patients with readmissions (13.1 ± 1.6 versus 12.9 ± 2.2, P = .37). 21 patients in the high LACE group were readmitted versus only 1 patient in the low LACE group (n = 8) (24% vs 13%, P = .68). Patients in the high LACE group had slightly longer length of stay (mean 8.6 ± 6.0 days versus 6.4 ± 8.9 days, P = .34) and higher mean number of medications (10.5 ± 3.4 versus 9.0 ± 3.0, P = .44). Overall, cognitive impairment was present in 42 patients (43%). Among patients with high LACE scores, patients with CI had a higher rate of readmissions (34% vs 15%, P = .03). Among patients with CI, 14 patients in the high LACE group were readmitted vs no patients in the low LACE group (34% vs 0%, P = .5). Conclusions: In patients with high LACE scores, presence of cognitive impairment is a predictor of 30-day readmissions. LACE score is an important predictive tool for readmissions and using it in concert with the mini-cog may help increase its predictive value for heart failure patients. Using these tools together may be helpful in guiding patient management and appropriate transitions of care.