Derivation and external validation of a simple risk tool to predict 30-day hospital readmissions after transcatheter aortic valve replacement.

Abstract

AIMS:

Patients undergoing transcatheter aortic valve replacement (TAVR) possess a higher risk of recurrent healthcare resource utilisation due to multiple comorbidities, frailty, and advanced age. We sought to devise a simple tool to identify TAVR patients at increased risk of 30-day readmission.

METHODS AND RESULTS:

We used the Nationwide Readmissions Database from January 2013 to September 2015. Complex survey methods and hierarchical regression in R were implemented to create a prediction tool to determine probability of 30-day readmission. Boot-strapped internal validation and cross-validation were performed to assess model accuracy. External validation was performed using a single-centre data set. Of 39,305 patients who underwent endovascular TAVR, 6,380 (16.2%) were readmitted within 30 days. The final 30-day readmission risk prediction tool included the following variables: chronic kidney disease, end-stage renal disease on dialysis (ESRD), anaemia, chronic lung disease, chronic liver disease, atrial fibrillation, length of stay, acute kidney injury, and discharge disposition. ESRD (OR 2.11, 95% CI: 1.7-2.63), length of stay ≥5 days (OR 1.64, 95% CI: 1.50-1.79), and short-term hospital discharge disposition (OR 1.81, 95% CI: 1.2-2.7) were the strongest predictors. The c-statistic of the prediction model was 0.63. The c-statistic in the external validation cohort was 0.69. On internal calibration, the tool was extremely accurate in predicting readmissions up to 25%.

CONCLUSIONS:

A simple and easy-to-use risk prediction tool utilising standard clinical parameters identifies TAVR patients at increased risk of 30-day readmission. The tool may consequently inform hospital discharge planning, optimise transitions of care, and reduce resource utilisation.

• Authors: Sahil Khera, Dhaval Kolte, Salil Deo, Ankur Kalra, Tanush Gupta, Dawn Abbott, Neal Kleiman, Deepak L Bhatt, Gregg C Fonarow, Omar K Khalique, Susheel Kodali, Martin B Leon, Sammy Elmariah
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 15 Issue 2 Pg. 155-163 (Jun 20 2019) ISSN: 1969-6213 [Electronic] France
• PMID: 30803938 (Publication Type: Journal Article)

Topics

• Aortic Valve
• Aortic Valve Stenosis
• Humans
• Patient Readmission
• Risk Factors
• Time Factors
• Transcatheter Aortic Valve Replacement
• Treatment Outcome