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Development and validation of a simple risk score to predict 30‐day readmission after percutaneous coronary intervention in a cohort of medicare patients
Author(s) -
Minges Karl E.,
Herrin Jeph,
Fiorilli Paul N.,
Curtis Jeptha P.
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26701
Subject(s) - medicine , conventional pci , framingham risk score , percutaneous coronary intervention , logistic regression , cohort , emergency medicine , stepwise regression , risk assessment , revascularization , myocardial infarction , computer security , disease , computer science
Objectives To develop a risk model that can be used to identify PCI patients at higher risk of readmission who may benefit from additional resources at the time of discharge. Background A high proportion of patients undergoing PCI are readmitted within 30 days of discharge. Methods The sample comprised patients aged ≥65 years who underwent PCI at a CathPCI Registry®‐participating hospital and could be linked with 100% Medicare fee‐for‐service claims between 01/2007 and 12/2009. The sample ( n = 388,078) was randomly divided into risk score development ( n = 193,899) and validation ( n = 194,179) cohorts. We did not count as readmissions those associated with staged revascularization procedures. Multivariable logistic regression models using stepwise selection models were estimated to identify variables independently associated with all‐cause 30‐day readmission. Results The mean 30‐day readmission rates for the development (11.36%) and validation (11.35%) cohorts were similar. In total, 19 variables were significantly associated with risk of 30‐day readmission ( P < 0.05), and model c‐statistics were similar in the development (0.67) and validation (0.66) cohorts. The simple risk score based on 14 variables identified patients at high and low risk of readmission. Patients with a score of ≥13 (15.4% of sample) had more than an 18.5% risk of readmission, while patients with a score ≤6 (41.9% of sample) had less than an 8% risk of readmission. Conclusion Among PCI patients, risk of readmission can be estimated using clinical factors present at the time of the procedure. This risk score may guide clinical decision‐making and resource allocation for PCI patients at the time of hospital discharge. © 2016 Wiley Periodicals, Inc.