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Abstract Background The LACE index—length of stay (L), acuity (A), Charlson co‐morbidities (C), and emergent visits (E)—predicts 30‐day outcomes following heart failure (HF) hospitalization but is complex to score. A simpler LE index (length of stay and emergent visits) could offer a practical advantage in point‐of‐care risk prediction. Methods and results This was a sub‐study of the patient‐centred care transitions in HF (PACT‐HF) multicentre trial. The derivation cohort comprised patients hospitalized for HF, enrolled in the trial, and followed prospectively. External validation was performed retrospectively in a cohort of patients hospitalized for HF. We used log‐binomial regression models with LACE or LE as the predictor and either 30‐day composite all‐cause readmission or death or 30‐day all‐cause readmission as the outcomes, adjusting only for post‐discharge services. There were 1985 patients (mean [SD] age 78.1 [12.1] years) in the derivation cohort and 378 (mean [SD] age 73.1 [13.2] years) in the validation cohort. Increments in the LACE and LE indices were associated with 17% (RR 1.17; 95% CI 1.12, 1.21; C‐statistic 0.64) and 21% (RR 1.21; 95% CI 1.15, 1.26; C‐statistic 0.63) increases, respectively, in 30‐day composite all‐cause readmission or death; and 16% (RR 1.16; 95% CI 1.11, 1.20; C‐statistic 0.64) and 18% (RR 1.18; 95% CI 1.13, 1.24; C‐statistic 0.62) increases, respectively, in 30‐day all‐cause readmission. The LE index provided better risk discrimination for the 30‐day outcomes than did the LACE index in the external validation cohort. Conclusions The LE index predicts 30‐day outcomes following HF hospitalization with similar or better performance than the more complex LACE index.

Abstract Aims Heart failure (HF) guidelines place patients into 3 discrete groups according to left ventricular ejection fraction (LVEF): reduced (

Abstract Aims The LE index (Length of hospitalization plus number of Emergent visits ≤6 months) predicts 30 day all‐cause readmission or death following hospitalization for heart failure (HF). We combined N‐terminal pro‐B type natriuretic peptide (NT‐proBNP) levels with the LE index to derive and validate the LENT index for risk prediction at the point of care on the day of hospital discharge. Methods and results In this prospective cohort sub‐study of the Patient‐centred Care Transitions in HF clinical trial, we used log‐binomial regression models with LE index and either admission or discharge NT‐proBNP as the predictors and 30 day composite all‐cause readmission or death as the primary outcome. No other variables were added to the model. We used regression coefficients to derive the LENT index and bootstrapping analysis for internal validation. There were 772 patients (mean [SD] age 77.0 [12.4] years, 49.9% female). Each increment in the LE index was associated with a 25% increased risk of the primary outcome (RR 1.25, 95% CI 1.16–1.35; C‐statistic 0.63). Adjusted for the LE index, every 10‐fold increase in admission and discharge NT‐proBNP was associated with a 48% (RR 1.48; 95% CI 1.10, 1.99; C‐statistic 0.64; net reclassification index [NRI] 0.19) and 56% (RR 1.56; 95% CI 1.08, 2.25; C‐statistic 0.64; NRI 0.21) increased risk of the primary outcome, respectively. The predicted probability of the primary outcome increased to a similar extent with incremental LENT, regardless of whether admission or discharge NT‐proBNP level was used. Conclusions The point‐of‐care LENT index predicts 30 day composite all‐cause readmission or death among patients hospitalized with HF, with improved risk reclassification compared with the LE index. The performance of this simple, 3‐variable index ‐ without adjustment for comorbidities ‐ is comparable to complex risk prediction models in HF. Trial Registration: ClinicalTrials.gov Identifier: NCT02112227