Abstract 257: Appraisal Of The Modified Lace Score In Heart Failure Admissions

Abstract

Background: Medicare’s Hospital Readmissions Reduction Program has focused on reducing the readmission rate in patients admitted for heart failure exacerbations. The LACE score has shown moderate to high predictive value in 30-day readmission and has been validated in heart failure cohorts. We sought to assess the utility of the LACE score in patients admitted for acute myocardial infarctions (AMI). Methods: The National Readmission Database was queried for 2016 and 2019 for adults admitted for acute myocardial infarctions. Patients were stratified by their modified LACE (mLACE) score index, substituting emergency department visits for prior admissions. Trends in 30-day readmission and healthcare utilization were analyzed. Results: Between 2016 and 2019, 2,018,837 patients were admitted for AMI. Stratified by mLACE score, 5.87% (n=118,634) were low-risk, 61.53 were moderate-risk (n=1,242,207), and 32.60% (n=657,997) were high-risk. Readmissions within 30 days occurred in 5.33%, 7.15%, and 14.99% for low, moderate, and high risk, respectively. The Kaplan Meier readmission curve is presented in Figure 1. Multivariate logistic regression showed moderate-risk had 16.60% higher odds of readmission, while high-risk had 77.16% higher odds of readmission. Length of stay (LOS) was 0.81 days for low risk, 2.92 days for moderate risk, and 8.40 days for high risk. Regression analysis showed LOS risk increased 63% for moderate-risk and was 6.16 times higher in high-risk admissions. Total cost was higher by $17,947 and $73,826 in moderate and high risk, respectively. Conclusion: The modified LACE index provides a feasible and cost-effective measurement of risk for readmission, mortality, and healthcare utilization. Patients with a high modified LACE index should be assessed for increased requirements upon discharge and readmission mitigation techniques