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Background: HF is a burden on healthcare resources due to the high cost of frequent readmissions. Predictive models have been reported for the post-discharge prognosis of HF. However, these models mostly included non-modifiable factors and their predictive accuracy was limited. This implies that potentially modifiable factors are needed, which could be attributed to the discharge process. This study aimed to explore the relationship between the discharge process and post-discharge events in patients with HF.Methods: Medical records were reviewed to identify patients who were admitted for HF exacerbation. Information related to the discharge process included post-discharge clinic appointments, educational contents before discharge, and family participation during patient education. HF-related events were defined as a composite of events, including emergency department visits, readmissions, or death. A multivariable Cox proportional hazards regression model was used to explore the association between the discharge process and HF-related events.Results: Of 201 patients, 41 had at least one HF-related event. Post-discharge clinic appointments were scheduled 8 days after discharge. Patients received their discharge education on average of one topic, and approximately the families of 70% of the patients participated in this educational activity. In the Cox regression model, family participation during education was independently associated with a longer time to HF events (hazard ratio: 2.105). However, and post-discharge follow-up appointments and the number of educational contents received were not associated with the time to HF events. Conclusion: We found that family participation during education is a protective factor for adverse prognosis in patients with HF. Our results highlight the importance of family engagement in HF management.

Background The Acute Physiology and Chronic Health Evaluation (APACHE) II model has been widely used in Korea. However, there have been few studies on the APACHE IV model in Korean intensive care units (ICUs). The aim of this study was to compare the ability of APACHE IV and APACHE II in predicting hospital mortality, and to investigate the ability of APACHE IV as a critical care triage criterion. Methods The study was designed as a prospective cohort study. Measurements of discrimination and calibration were performed using the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test respectively. We also calculated the standardized mortality ratio (SMR). Results The APACHE IV score, the Charlson Comorbidity index (CCI) score, acute respiratory distress syndrome, and unplanned ICU admissions were independently associated with hospital mortality. The calibration, discrimination, and SMR of APACHE IV were good (H = 7.67, P = 0.465; C = 3.42, P = 0.905; AUROC = 0.759; SMR = 1.00). However, the explanatory power of an APACHE IV score >93 alone on hospital mortality was low at 44.1%. The explanatory power was increased to 53.8% when the hospital mortality was predicted using a model that considers APACHE IV >93 scores, medical admission, and risk factors for CCI >3 coincidentally. However, the discriminative ability of the prediction model was unsatisfactory (C index Conclusions The APACHE IV presented good discrimination, calibration, and SMR for hospital mortality.