Interventions for valvular disease and heart failure

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

EuroIntervention 2019;15:155-163. DOI: 10.4244/EIJ-D-18-00954

Sahil Khera
Sahil Khera1,2, MD, MPH; Dhaval Kolte2, MD, PhD; Salil Deo3, MD; Ankur Kalra3, MD; Tanush Gupta4, MD; Dawn Abbott5; Neal Kleiman6, MD; Deepak L. Bhatt7, MD, MPH; Gregg C. Fonarow8, MD; Omar K. Khalique1, MD; Susheel Kodali1, MD; Martin B. Leon1, MD; Sammy Elmariah2, MD, MPH
1. Columbia University Medical Center, New York, NY, USA; 2. Massachusetts General Hospital, Boston, MA, USA; 3. University Hospitals Cleveland Medical Center, Cleveland, OH, USA; 4. Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA; 5. Warren Alpert Medical School, Brown University, Providence, RI, USA; 6. Houston Methodist, Houston, TX, USA; 7. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 8. David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

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.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

miscellaneousrisk stratificationtavi
Interventions for valvular diseaseTAVI
Read next article
Interatrial shunting for heart failure: current evidence and future perspectives

Latest news