Development and validation of dynamic nomogram of frailty risk for older patients hospitalized with heart failure

IF 2.9 3区 医学 Q1 NURSING International Journal of Nursing Sciences Pub Date : 2023-04-01 DOI:10.1016/j.ijnss.2023.03.014
Qian Li , Yanping Chen , Dechun Qin , Shumei Li , Shiyu Zhang , Liu Fang , Jiafeng Zhu , Yingchao Wang , Yanan Mao , Lane Zhang
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Abstract

Objective

This study aimed to establish and validate a dynamic online nomograph for predicting the risk of frailty in older patients hospitalized with heart failure in China.

Methods

A total of 451 older adults with heart failure hospitalized were selected between December 2021 and November 2022 at the Department of Cardiovascular Medicine in a Class A tertiary hospital in Shandong, China. The data of patients were obtained by using Barthel Index, instrumental activity of daily living scale, mini nutrition assessment-short form, Pittsburgh sleep quality index scale, Morse fall risk assessment scale and general information scale. The brain natriuretic peptide and echocardiographic indexes of patients were collected by electronic medical records. All participants were randomly divided into the training set (n = 319) and the validation set (n = 132) at the ratio of 7:3. The training set is used for model construction, and the validation set is used for internal validation. Using the Least Absolute Shrinkage and Selection Operator (LASSO) regression method to filter modeling variables, while the multivariable logistic regression was used to establish the nomogram based on the screened optimal variables. The performance of the model was evaluated by the area under the curve (AUC) of the receiver operator characteristic (ROC) curve, Hosmer-Lemeshow test, calibration plot, and decision curve analysis (DCA).

Results

The prevalence of frailty in 451 patients was 50.6%, 51.4%, and 48.5% in the training and validation sets, respectively. Drinking, grip strength, New York Heart Association (NYHA) class, multimorbidity, hospitalization history of heart failure, Barthel Index, the instrumental activities of daily living, nutritional status, sleep, fall, and left atrial end-diastolic diameter were used for LASSO regression analysis as the significant predictors of frailty. According to internal validation, the AUC of the ROC curve for the nomogram was 0.920, with a sensitivity of 86.8% and specificity of 84.4%. Moreover, in the validation set, the P-values of the H-L test were 0.742, and the calibration curve had good concordance between the estimated frailty risk and actual observation, indicating the model was well-calibrated. The DCA results confirmed that the nomogram had a well-performance in clinical suitability.

Conclusions

An online dynamic nomogram predicting frailty for older patients hospitalized for heart failure in China was well-established and identified in this study. This model benefits medical professionals in identifying high-risk frailty in older hospitalized patients with heart failure, which could reduce the medical and disease burden of heart failure to a certain extent. However, further verification is needed in the future.

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老年心力衰竭住院患者衰弱风险动态图的开发与验证
目的本研究旨在建立和验证一个动态在线列线图,用于预测中国老年心力衰竭住院患者的虚弱风险。方法选择2021年12月至2022年11月在山东一家三甲医院心血管内科住院的451名老年心力衰竭患者。患者数据采用Barthel指数、日常生活工具活动量表、迷你营养评估简表、匹兹堡睡眠质量指数量表、Morse跌倒风险评估量表和一般信息量表。通过电子病历采集患者的脑钠肽和超声心动图指标。所有参与者按7:3的比例随机分为训练集(n=319)和验证集(n=132)。训练集用于模型构建,验证集用于内部验证。使用最小绝对收缩和选择算子(LASSO)回归方法对建模变量进行过滤,而使用多变量逻辑回归方法在筛选出的最优变量的基础上建立列线图。通过受试者-操作者特征(ROC)曲线的曲线下面积(AUC)、Hosmer-Lemeshow检验、校准图和决策曲线分析(DCA)来评估模型的性能。结果451名患者的虚弱患病率分别为50.6%、51.4%和48.5%。饮酒、握力、纽约心脏协会(NYHA)分级、多发性疾病、心力衰竭住院史、Barthel指数、日常生活工具活动、营养状况、睡眠、跌倒和左心房舒张末期直径被用于LASSO回归分析,作为虚弱的重要预测因素。根据内部验证,列线图ROC曲线的AUC为0.920,灵敏度为86.8%,特异性为84.4%。此外,在验证集中,H-L检验的P值为0.742,校准曲线在估计的虚弱风险和实际观察之间具有良好的一致性,表明该模型校准良好。DCA结果证实诺模图在临床适用性方面具有良好的性能。结论在本研究中,一个预测中国因心力衰竭住院的老年患者虚弱程度的在线动态列线图已经建立并确定。这种模式有利于医疗专业人员识别老年心力衰竭住院患者的高危虚弱,这可以在一定程度上减轻心力衰竭的医疗和疾病负担。不过,今后还需要进一步核查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.10
自引率
2.60%
发文量
408
审稿时长
25 days
期刊介绍: This journal aims to promote excellence in nursing and health care through the dissemination of the latest, evidence-based, peer-reviewed clinical information and original research, providing an international platform for exchanging knowledge, research findings and nursing practice experience. This journal covers a wide range of nursing topics such as advanced nursing practice, bio-psychosocial issues related to health, cultural perspectives, lifestyle change as a component of health promotion, chronic disease, including end-of-life care, family care giving. IJNSS publishes four issues per year in Jan/Apr/Jul/Oct. IJNSS intended readership includes practicing nurses in all spheres and at all levels who are committed to advancing practice and professional development on the basis of new knowledge and evidence; managers and senior members of the nursing; nurse educators and nursing students etc. IJNSS seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Contributions are welcomed from other health professions on issues that have a direct impact on nursing practice.
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Editorial Board Contents Web-based cognitive interventions on subjective cognitive impairment in cancer survivors: A systemic review A concept analysis of vicarious resilience in mental health nursing Evaluating the feasibility and preliminary effects of an online compassion training program for nursing students: A pilot randomized controlled trial
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