Risk factors for perioperative acute heart failure in elderly hip fracture patients and establishment of a nomogram predictive model

Abstract Objective This study aims to explore the risk factors of perioperative acute heart failure in elderly patients with hip fractures and establish a nomogram prediction model. Methods The present study was designed as retrospective. From January 2020 to December 2021, patients who underwent surgical treatment for hip fractures at the Third Hospital of Hebei Medical University were included. Patients with heart failure were confirmed by discharge diagnosis or medical records. Samples were randomly divided into modeling and validation cohorts at a ratio of 7:3. The demographic and relevant clinic data of patients were collected. Univariate and multivariate logistic regression analyses were conducted by IBM SPSS Statistics 26.0, to obtain the risk factors of acute heart failure. R software was used to construct the nomogram prediction model. Results A total of 751 elderly patients with hip fractures were enrolled in this study, of which 138 patients (18.37%, 138/751) developed acute heart failure. Patients with heart failure were confirmed by discharge diagnosis or medical records. Respiratory disease (odd ratio, 7.135; 95% confidence interval, 3.615–14.081; P value, 0.001), cardiovascular disease (odd ratio, 2.250, 95% confidence interval, 1.214–4.170; P value, 0.010), ASA ≥ 3 (odd ratio, 13.733, 95% confidence interval, 7.465–25.265; P value, 0.001), and preoperative waiting time ≤ 2 days (odd ratio, 3.271, 95% confidence interval, 1.315–8.134; P value, 0.011) were the independent risk factors of perioperative acute heart failure in elderly patients with hip fracture. The area under the curve (AUC) of the prediction model based on the above factors was calculated to be 0.877 (95% confidence interval 0.836–0.918). The sensitivity and specificity were 82.8% and 80.9% respectively, and the fitting degree of the model was good. In the internal validation group, the area under the curve (AUC) was 0.910, the 95% confidence interval was 0.869–0.950. Conclusions Our nomogram model can be used to predict the risk of acute heart failure in elderly hip fractures during the perioperative period and provide guidance on the prevention of acute heart failure.