BackgroundThe LACE index has been used to predict the risk of unplanned readmission within 30 days after hospital discharge in both medical and surgical patients. The aim of this study is to validate the accuracy of using the LACE index in CHF patients.MethodsThis was a retrospective study. The LACE index score was calculated on each patient who was admitted to hospital due to an acute CHF exacerbation. Operational and clinical variables were collected from patients including basic clinical characteristics, length of hospitalization, comorbidities, number of previous ED visits in the past 6 months before the index admission, and the number of post discharge ED revisits at 30, 60, and 90 days. All variables were analyzed by multivariate logistic regression to determine the association between clinical variables and the hospital unplanned readmissions. C-statistic was used to discriminate those patients with high risk of readmissions.ResultsOf the 253 patients included in the study, 24.50% (62/253) experienced unplanned readmission to hospital within 30 days after discharge. The LACE index was slightly higher in patients readmitted versus patients not readmitted (12.17 ± 2.22 versus 11.80 ± 1.92, p = 0.199). Adjusted odds ratios based on logistic regression of all clinical variables showed only the number of previous ED visits (OR 1.79, 95% CI 1.30-2.47, p < 0.001), history of myocardial infarction (OR 2.51, 95% CI 1.02-6.21, p = 0.045), and history of peripheral vascular disease (OR 10.75, 95% CI 1.52-75.73, p = 0.017) increased the risk of unplanned readmission within 30 days of hospital discharge. However, patients with high LACE scores (≥10) had a significantly higher rate of ED revisits (15.04% vs 0%) within 30 days from the index discharge than those with low LACE scores (p = 0.030).ConclusionThe LACE index may not accurately predict unplanned readmissions within 30 days from hospital discharge in CHF patients. The LACE high risk index may have utility as a screening tool to predict high risk ED revisits after hospital discharge.

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El artículo, junto con describir históricamente el nivel de interés de la sociedad chilena por la defensa nacional entre los años 1910 y 1960, analiza los factores políticos y militares que influyeron en el rango de desarrollo de esa función del Estado, dejando de manifiesto los vacíos conceptuales y los efectos que, sobre su estructuración formal, provocaron los ambientes de crisis e inestabilidad institucional que se expresaron en parte importante del período objeto de estudio, junto a la ausencia de una relación político-militar concordante con la intención de disponer de una defensa nacional que reflejara las experiencias del país en el campo del empleo de la fuerza obtenidas durante el siglo XIX o aquellas provenientes de enfrentamientos bélicos ocurridos en el desenvolvimiento mundial en el siguiente. Todo ello, en definitiva, impidió consolidar las intenciones dirigidas a conformar el dispositivo que requería la seguridad exterior del país. En consecuencia, hasta 1960 no se lograron definir los procesos, las estructuras y los actores del mismo con el objeto de permitir una conducción integral de la defensa frente a potenciales amenazas foráneas a la seguridad nacional.