Dynamic Prediction for Hospital Readmission in Patients with Chronic Heart Failure

Abstract

Hospital readmission among patients with chronic heart failure (HF) is a major clinical and economic burden. Dynamic prediction models that leverage longitudinal biomarkers may improve risk stratification over traditional static models. This study aims to develop and validate a joint model using longitudinal N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements to predict the risk of rehospitalization or death in HF patients. We analyzed real-world data from the TriNetX database, including patients with an incident HF diagnosis between 2016 and 2022. The final selected cohort included 1,804 patients. A Bayesian joint modeling framework was developed to link patient-specific NT-proBNP trajectories to the risk of a composite endpoint (HF rehospitalization or all-cause mortality) within a 180-day window following hospital discharge. The model's performance was evaluated using 5-fold cross-validation and assessed with the Integrated Brier Score and Integrated Calibration Index. The joint model demonstrated a strong predictive advantage over a benchmark static model, particularly when making updated predictions at later time points (180-360 days). A joint model trained on patients with more frequent NT-proBNP measurements achieved the highest accuracy. The main joint model showed excellent calibration, suggesting its risk estimates are reliable. Our findings suggest that modeling the full trajectory of NT-proBNP with a joint modeling framework enables more accurate and dynamic risk assessment compared to static, single-timepoint methods. This approach supports the development of adaptive clinical decision-support tools for personalized HF management.