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Text
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<a href="http://doi.org/10.4244/EIJ-D-18-00954" target="_blank" rel="noreferrer noopener">http://doi.org/10.4244/EIJ-D-18-00954</a>
Pages
155-163
Issue
2
Volume
15
ISSN
1969-6213 1774-024X
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<a href="http://neomed.idm.oclc.org/login?url=http://doi.org/10.4244/EIJ-D-18-00954" target="_blank" rel="noreferrer noopener">NEOMED Full-text Holding (if available) - Proxy DOI: 10.4244/EIJ-D-18-00954</a>
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Update Year & Number
June2020SubmittedList
NEOMED College
NEOMED College of Medicine
NEOMED Department
Department of Internal Medicine
Affiliated Hospital
Cleveland Clinic Akron General Hospital
Dublin Core
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Title
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Derivation and external validation of a simple risk tool to predict 30-day hospital readmissions after transcatheter aortic valve replacement.
Publisher
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EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Date
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2019
2019-06-20
Subject
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Humans; Treatment Outcome; Risk Factors; Time Factors; Aortic Valve; Patient Readmission; Aortic Valve Stenosis; Transcatheter Aortic Valve Replacement
Creator
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Khera S; Kolte D; Deo VS; Kalra A; Gupta T; Abbott JD; Kleiman NS; Bhatt DL; Fonarow GC; Khalique OK; Kodali S; Leon MB; Elmariah S
Description
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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.
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<a href="http://doi.org/10.4244/EIJ-D-18-00954" target="_blank" rel="noreferrer noopener">10.4244/EIJ-D-18-00954</a>
PMID: 30803938
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Copyright © 2019. Published by Elsevier Inc.
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journalArticle
2019
Abbott JD
Aortic Valve
Aortic Valve Stenosis
Bhatt DL
Cleveland Clinic Akron General Hospital
Deo VS
Department of Internal Medicine
Elmariah S
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Fonarow GC
Gupta T
Humans
journalArticle
June2020SubmittedList
Kalra A
Khalique OK
Khera S
Kleiman NS
Kodali S
Kolte D
Leon MB
NEOMED College of Medicine
Patient Readmission
Risk Factors
Time Factors
transcatheter aortic valve replacement
Treatment Outcome