Wasfy et al developed a model for predicting 30-day readmission following a percutaneous coronary intervention (PCI). These can help to identify a patient who may benefit from more aggressive management. The authors are from Massachusetts General Hospital, Harvard University, Wellmont CVA Heart Institute, Saint Luke's Mid America Heart Institute/UMKC, Brigham and Women's Hospital.
Patient selection: percutaneous coronary intervention
Outcome: 30-day readmission
Parameters:
(1) gender
(2) previous coronary artery bypass graft (CABG)
(3) current congestive heart failure (CHF)
(4) chronic lung disease
(5) peripheral arterial disease
(6) cardiogenic shock
(7) age in years
(8) glomerular filtration rate (GFR) in mL per minute
(9) admission status
(10) insurance status
|
Parameter |
Finding |
Points |
|
gender |
male |
0 |
|
|
female |
2 |
|
previous CABG |
none |
0 |
|
|
yes |
1 |
|
current CHF |
no |
0 |
|
|
yes |
2 |
|
chronic lung disease |
no |
0 |
|
|
yes |
2 |
|
peripheral arterial disease |
no |
0 |
|
|
yes |
1 |
|
cardiogenic shock |
no |
0 |
|
|
yes |
2 |
|
age in years |
< 50 years |
0 |
|
|
>= 50 years |
-1 |
|
GFR |
> 60 mL per minute |
0 |
|
|
30 to 60 mL per minute |
1 |
|
|
< 30 mL per minute |
4 |
|
admission status |
transfer from acute care facility |
3 |
|
|
transfer from nursing home |
4 |
|
|
Emergency Department |
4 |
|
|
other |
0 |
|
insurance status |
private |
0 |
|
|
medicare or state |
3 |
|
|
unknown |
4 |
where:
• "Other" for admission status would include outpatient referral (see Table 1).
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: -1
• maximum score: 22
• The higher the score the greater the risk for readmission.
|
Score |
Risk Group |
30-Day Readmission |
|
< 6 |
low |
< 9% |
|
6 to 10 |
intermediate |
10 to 21% |
|
>= 11 |
high |
> 24% |
Purpose: To predict the rate of 30-day readmission for a patient being discharged after a percutaneous coronary intervention (PCI) based on the study of Wasfy et al.
Objective: risk factors, severity, prognosis, stage
ICD-10: I20, I21, I25, Y84.0,
