Prediction models for hospital readmissions in patients with heart disease: a systematic review and meta-analysis.
adverse events
cardiology
risk management
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
17 08 2021
17 08 2021
Historique:
entrez:
18
8
2021
pubmed:
19
8
2021
medline:
28
8
2021
Statut:
epublish
Résumé
To describe the discrimination and calibration of clinical prediction models, identify characteristics that contribute to better predictions and investigate predictors that are associated with unplanned hospital readmissions. Systematic review and meta-analysis. Medline, EMBASE, ICTPR (for study protocols) and Web of Science (for conference proceedings) were searched up to 25 August 2020. Studies were eligible if they reported on (1) hospitalised adult patients with acute heart disease; (2) a clinical presentation of prediction models with c-statistic; (3) unplanned hospital readmission within 6 months. Model discrimination for unplanned hospital readmission within 6 months measured using concordance (c) statistics and model calibration. Meta-regression and subgroup analyses were performed to investigate predefined sources of heterogeneity. Outcome measures from models reported in multiple independent cohorts and similarly defined risk predictors were pooled. Sixty studies describing 81 models were included: 43 models were newly developed, and 38 were externally validated. Included populations were mainly patients with heart failure (HF) (n=29). The average age ranged between 56.5 and 84 years. The incidence of readmission ranged from 3% to 43%. Risk of bias (RoB) was high in almost all studies. The c-statistic was <0.7 in 72 models, between 0.7 and 0.8 in 16 models and >0.8 in 5 models. The study population, data source and number of predictors were significant moderators for the discrimination. Calibration was reported for 27 models. Only the GRACE (Global Registration of Acute Coronary Events) score had adequate discrimination in independent cohorts (0.78, 95% CI 0.63 to 0.86). Eighteen predictors were pooled. Some promising models require updating and validation before use in clinical practice. The lack of independent validation studies, high RoB and low consistency in measured predictors limit their applicability. CRD42020159839.
Identifiants
pubmed: 34404703
pii: bmjopen-2020-047576
doi: 10.1136/bmjopen-2020-047576
pmc: PMC8372817
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e047576Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Aust Crit Care. 2012 Feb;25(1):31-40
pubmed: 21889893
BMC Med Inform Decis Mak. 2019 Oct 15;19(1):193
pubmed: 31615569
Int J Cardiol. 2017 Oct 15;245:162-167
pubmed: 28874288
J Am Heart Assoc. 2016 Aug 31;5(9):
pubmed: 27581171
Catheter Cardiovasc Interv. 2017 May;89(6):955-963
pubmed: 27515069
BMJ Open. 2016 Jun 27;6(6):e011060
pubmed: 27354072
Am Heart J. 2018 Sep;203:85-92
pubmed: 30053692
Am J Cardiol. 2017 May 1;119(9):1428-1432
pubmed: 28302271
Ann Appl Stat. 2016 Mar;10(1):286-304
pubmed: 27158296
Med Care. 2010 Nov;48(11):981-8
pubmed: 20940649
Ann Intern Med. 2019 Jan 1;170(1):51-58
pubmed: 30596875
Rev Port Cardiol. 2015 Jun;34(6):383-91
pubmed: 26051757
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
J Clin Monit Comput. 2013 Aug;27(4):455-64
pubmed: 23504197
JACC Heart Fail. 2014 Oct;2(5):440-6
pubmed: 25194291
Circ Cardiovasc Qual Outcomes. 2011 Mar;4(2):243-52
pubmed: 21406673
Stat Med. 2006 Feb 28;25(4):559-73
pubmed: 16217835
Am Heart J. 2012 Sep;164(3):365-72
pubmed: 22980303
J Nurs Home Res Sci. 2019;5:60-67
pubmed: 32518890
Ann Thorac Surg. 2020 Jun;109(6):1797-1803
pubmed: 31706877
Appl Health Econ Health Policy. 2014 Dec;12(6):573-85
pubmed: 25160603
Can J Cardiol. 2018 Dec;34(12):1655-1664
pubmed: 30527155
Am J Cardiol. 2018 Feb 1;121(3):322-329
pubmed: 29248155
Circ Cardiovasc Qual Outcomes. 2008 Sep;1(1):29-37
pubmed: 20031785
Med Care. 1999 Jul;37(7):625-36
pubmed: 10424633
Arch Intern Med. 2008 Jul 14;168(13):1371-86
pubmed: 18625917
PLoS One. 2020 Jan 15;15(1):e0224135
pubmed: 31940350
Circ Cardiovasc Qual Outcomes. 2018 Oct;11(10):e004788
pubmed: 30354578
Biomed Res Int. 2017;2017:7420738
pubmed: 29201912
Circ Cardiovasc Qual Outcomes. 2018 Jan;11(1):e003885
pubmed: 29321135
J Thorac Dis. 2019 Mar;11(Suppl 4):S574-S584
pubmed: 31032076
Curr Heart Fail Rep. 2019 Dec;16(6):304-314
pubmed: 31768916
Ann Thorac Surg. 2018 Nov;106(5):1294-1301
pubmed: 30086283
Am Heart J. 2018 Jun;200:75-82
pubmed: 29898852
Heart. 2014 Jan;100(2):115-25
pubmed: 24179162
Circ Cardiovasc Qual Outcomes. 2019 May;12(5):e005320
pubmed: 31010300
J Card Surg. 2018 Apr;33(4):163-170
pubmed: 29569750
Med Care Res Rev. 2016 Feb;73(1):3-40
pubmed: 26180045
Am Heart J. 2016 Sep;179:51-8
pubmed: 27595679
Heart Lung Circ. 2019 Dec;28(12):1896-1903
pubmed: 30528815
Eval Health Prof. 2001 Jun;24(2):126-51
pubmed: 11523383
Mayo Clin Proc Innov Qual Outcomes. 2017 Dec 01;1(3):211-218
pubmed: 30225419
J Cardiol. 2019 Feb;73(2):108-113
pubmed: 30360893
J Cardiovasc Med (Hagerstown). 2015 Mar;16(3):238-45
pubmed: 25111771
Epidemiology. 2011 Nov;22(6):805-12
pubmed: 21968770
Mayo Clin Proc. 2014 May;89(5):623-30
pubmed: 24684780
Aust Health Rev. 2014 Sep;38(4):377-82
pubmed: 25001433
J Am Heart Assoc. 2018 Apr 17;7(8):
pubmed: 29666065
Circulation. 2020 Mar 3;141(9):e139-e596
pubmed: 31992061
Eur J Cardiovasc Nurs. 2018 Dec;17(8):675-689
pubmed: 30189748
Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):500-7
pubmed: 20031883
Circ Cardiovasc Qual Outcomes. 2013 Jul;6(4):429-35
pubmed: 23819957
Heart Lung. 2016 Jan-Feb;45(1):29-33
pubmed: 26481383
BMJ. 2020 Apr 8;369:m958
pubmed: 32269037
EuroIntervention. 2019 Jun 20;15(2):155-163
pubmed: 30803938
Int J Cardiol. 2017 Jun 1;236:304-309
pubmed: 28407978
Circ Cardiovasc Qual Outcomes. 2011 Jan 1;4(1):60-7
pubmed: 21139093
J Thorac Cardiovasc Surg. 2001 Aug;122(2):278-86
pubmed: 11479500
Am J Med. 2019 Feb;132(2):217-226
pubmed: 30419227
Med Care. 2017 Mar;55(3):285-290
pubmed: 27755392
J Thorac Cardiovasc Surg. 2015 Mar;149(3):850-7.e1; discussion 857
pubmed: 25293357
Ann Thorac Surg. 2018 Apr;105(4):1086-1093
pubmed: 29288658
Heart Lung. 2018 Jul - Aug;47(4):290-296
pubmed: 29853327
Gen Thorac Cardiovasc Surg. 2019 Aug;67(8):661-668
pubmed: 30734216
J Card Fail. 2015 Nov;21(11):885-91
pubmed: 26209002
Cardiovasc Revasc Med. 2020 Mar;21(3):263-270
pubmed: 31255552
JAMA Cardiol. 2017 Feb 1;2(2):204-209
pubmed: 27784047
Ann Thorac Surg. 2017 Jan;103(1):66-73
pubmed: 27546600
BMC Cardiovasc Disord. 2014 Aug 07;14:97
pubmed: 25099997
Heart Lung Circ. 2015 Nov;24(11):1068-73
pubmed: 26048319
BMC Cardiovasc Disord. 2016 Nov 8;16(1):212
pubmed: 27821064
Ann Thorac Surg. 2018 May;105(5):1384-1391
pubmed: 29288657
BMJ Evid Based Med. 2020 Oct;25(5):166-167
pubmed: 31771947