Sanchez et al developed a calculator for predicting the risk of unplanned readmission following insertion of a self-expanding transcatheter aortic valve replacement. This can help to identify a patient who may benefit from more aggressive management. The authors are from Riverside Methodist Hospital (Columbus), St. Vincent's Medical Center (Indianapolis), Beth Israel Deaconess Medical Center, University of Michigan, Yale University and Medtronic.
Patient selection: insertion of a self-expanding transcatheter aortic valve replacement
Outcome: unplanned readmission within 30 days of discharge
Parameters:
(1) diabetes mellitus
(2) atrial fibrillation/flutter
(3) 5 meter gait speed
(4) home oxygen
(5) NYHA class
(6) post-procedural mitral regurgitation
(7) post procedural aortic regurgitation
(8) post-procedural serum creatinine in mg/dL
(9) major vascular complication in the index hospitalization
(10) length of stay for index admission in days
Parameter
Finding
Points
diabetes mellitus
no
0
yes
1
atrial fibrillation/flutter
no
0
yes
2
5-meter gait speed
< 6 seconds
0
>= 6 seconds
1
unable to walk
1
home oxygen
no
0
yes
1
NYHA class
I or II
0
III or IV
1
mitral regurgitation
none or mild
0
moderate or severe
1
aortic regurgitation
none or mild
0
moderate or severe
2
serum creatinine
< 1.6 mg/dL
0
>= 1.6 mg/dL
2
major vascular complications
no
0
yes
2
length of stay
< 5 days
0
>= 5 days
1
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 14
• The higher the score the greater the risk of readmission.
Total Score
Readmission Risk
0 or 1
low
2 to 4
intermediate
>= 5
high
Performance:
• The area under the ROC curve is 0.60.
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