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New tool predicts readmission among TAVR patients

by John R. Fischer, Senior Reporter | May 11, 2018
Cardiology
A new tool may predict the
risk of 30-day readmissions among
TAVR patients
Thirty day readmission rates for TAVR patients may soon become predictable events among providers equipped with a new risk scoring tool.

That’s what researchers behind a study on the device claimed in their findings at the Society of Cardiovascular Angiography and Interventions 2018 Scientific Sessions, elaborating on its ability to score a patient’s risk of being readmitted following TAVR procedures.

"The creation of this tool and the results of the study are very assuring because it allows for better understanding of how patients should be managed peri-TAVR,” lead author Sahil Khera, a clinical and research fellow of interventional cardiology at Massachusetts General Hospital, said in a statement. “By recognizing patients at higher risk of readmission, we can guide post discharge care coordination and improve transitions of care to decrease readmission, improve quality of life, reduce healthcare costs and ultimately impact mortality rates.”

More than five million Americans are diagnosed with heart valve disease annually. Of those that undergo TAVR, nearly 15-20 percent are readmitted within 30 days, affecting positive outcomes, and together, racking up more than $40 billion in hospital costs annually.

The tool provides clinicians and medical professionals with a score to determine which patients are most at risk to be readmitted within 30 days. Probability scores are based on complex survey methods, hierarchical regression and the "rms" library.

The study examined 39,305 patients from the Nationwide Readmissions Database who underwent endovascular TAVR from January 2013 to September 2015 with researchers performing an international calibration with bootstrapping.

The final risk tool took into consideration chronic kidney disease, end stage renal disease on dialysis, anemia, chronic lung disease, chronic liver disease, atrial fibrillation, lengths of stay for more than five days, acute kidney injury, and discharge disposition.

Researchers recorded a score of 212 associated, with a readmission rate of more than 30 percent. Of the initial number of patients, 6,380 patients were readmitted within 30 days, a rate of 16.2 percent. The c-statistic of the model was 0.63.

"Use of the simple risk tool will allow the entire care team to quantify readmission risk and enhance our ability to provide personalized transitional care to hopefully mitigate this risk," said co-author Sammy Elmariah, director of interventional structural heart disease at Massachusetts General Hospital, in a statement.

The authors hope to begin using and incorporating the tools in hospital EMRs nationwide.

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