A Clinical Risk Scoring Tool to Predict Readmission After Cardiac Surgery: An Ontario Administrative and Clinical Population Database Study

2018 ◽  
Vol 34 (12) ◽  
pp. 1655-1664 ◽  
Author(s):  
Derrick Y. Tam ◽  
Jiming Fang ◽  
Andrew Tran ◽  
Jack V. Tu ◽  
Dennis T. Ko ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Population ◽  
Population Database ◽  
Database Study ◽  
Clinical Risk ◽  
Risk Scoring ◽  
Scoring Tool

Risk scoring by CHADS2 and CHA2DS2-VASc as predictors for long-term outcomes after surgical ablation for atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Lauritzen ◽  
H.J Vodstrup ◽  
T.D Christensen ◽  
M Onat ◽  
R Christensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Isolation Procedure ◽  
Survival Times ◽  
Long Term Outcomes ◽  
Surgical Ablation ◽  
Follow Up Study ◽  
Risk Scoring

Abstract Background Following catheter ablation for atrial fibrillation (AF), CHADS2 and CHA2DS2-VASc have utility in predicting long-term outcomes. However, it is currently unknown if the same holds for patients undergoing surgical ablation. Purpose To determine whether CHADS2 and CHA2DS2-VASc predict long-term outcomes after surgical ablation in concomitance with other cardiac surgery. Methods In this prospective, follow-up study, we included patients who underwent biatrial ablation - or pulmonary vein isolation procedure concomitantly with other cardiac surgery between 2004 and 2018. CHADS2 and CHA2DS2-VASc scores were assessed prior to surgery and categorized in groups as 0–1, 2–4 or ≥5. Outcomes were death, AF, and AF-related death. Follow-up was ended in April 2019. Results A total of 587 patients with a mean age of 68.7±0.4 years were included. Both CHADS2 and CHA2DS2-VASc scores were predictors of survival p=0.005 and p<0.001, respectively (Figure). For CHADS2, mean survival times were 5.9±3.7 years for scores 0–1, 5.0±3.0 years for scores 2–4 and 4.3±2.6 years for scores ≥5. For CHA2DS2-VASc mean survival times were 7.3±4.0 years for scores 0–1, 5.6±2.9 years for scores 2–4 and 4.8±2.1 years for scores ≥5. The incidence of death was 20.1% for CHADS2 0–1, 24.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.186. The incidence of AF was 50.2% for CHADS2 0–1, 47.9% for CHADS2 2–4, and 76.5% for CHADS2 ≥5, p=0.073. The incidence of AF related death was 13.0% for CHADS2 0–1, 16.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.031. The incidence of death was 16.8% for CHA2DS2-VASc 0–1, 26.2% for CHA2DS2-VASc 2–4, and 45.0% for CHA2DS2-VASc ≥5, p=0.001. The incidence of AF was 49.6% for CHA2DS2-VASc 0–1, 52.5% for CHA2DS2-VASc 2–4, and 72.5% for CHA2DS2-VASc ≥5, p=0.035. The incidence of AF related death was 12.2% for CHA2DS2-VASc 0–1, 16.0% for CHA2DS2-VASc 2–4, and 42.5% for CHA2DS2-VASc ≥5, p<0.001. Conclusion Both CHADS2 and CHA2DS2-VASc scores predict long-term outcomes after surgical ablation for AF. However, CHA2DS2-VASc was superior in predicting death, AF, and AF-related death. Survival curves Funding Acknowledgement Type of funding source: None

scholarly journals Developing a scoring tool to estimate the risk of deterioration for normotensive patients with acute pulmonary embolism on admission

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yizhuo Gao ◽  
Chao Ji ◽  
Hongyu Zhao ◽  
Jun Han ◽  
Haitao Shen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Clinical Laboratory ◽  
Systolic Pressure ◽  
Adverse Outcomes ◽  
Web Based ◽  
Derivation Cohort ◽  
Risk Scoring ◽  
Scoring Tool ◽  
Acute Pe

Abstract Background It is important to identify deterioration in normotensive patients with acute pulmonary embolism (PE). This study aimed to develop a tool for predicting deterioration among normotensive patients with acute PE on admission. Methods Clinical, laboratory, and computed tomography parameters were retrospectively collected for normotensive patients with acute PE who were treated at a Chinese center from January 2011 to May 2020 on admission into the hospital. The endpoint of the deterioration was any adverse outcome within 30 days. Eligible patients were randomized 2:1 to derivation and validation cohorts, and a nomogram was developed and validated by the aforementioned cohorts, respectively. The areas under the curves (AUCs) with 95% confidence intervals (CIs) were calculated. A risk-scoring tool for predicting deterioration was applied as a web-based calculator. Results The 845 eligible patients (420 men, 425 women) had an average age of 60.05 ± 15.43 years. Adverse outcomes were identified for 81 patients (9.6%). The nomogram for adverse outcomes included heart rate, systolic pressure, N-terminal-pro brain natriuretic peptide, and ventricle/atrial diameter ratios at 4-chamber view, which provided AUC values of 0.925 in the derivation cohort (95% CI 0.900–0.946, p < 0.001) and 0.900 in the validation cohort (95% CI 0.883–0.948, p < 0.001). A risk-scoring tool was published as a web-based calculator (https://gaoyzcmu.shinyapps.io/APE9AD/). Conclusions We developed a web-based scoring tool that may help predict deterioration in normotensive patients with acute PE.

scholarly journals Validating a Scoring Tool to Predict Acute Kidney Injury (AKI) following Cardiac Surgery

2015 ◽  
Vol 2 ◽  
pp. 37 ◽  
Author(s):  
Brian Wong ◽  
Jennifer St. Onge ◽  
Stephen Korkola ◽  
Bhanu Prasad
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Scoring Tool

Development of a Risk Scoring Tool to Predict HIV-1 Acquisition in African Women

2014 ◽  
Vol 30 (S1) ◽  
pp. A214-A214 ◽  
Author(s):  
Jennifer E. Balkus ◽  
Jingyang Zhang ◽  
Gonasagrie Nair ◽  
Thesla Palanee ◽  
Gita Ramjee ◽  
...  
Keyword(s):  
African Women ◽  
Risk Scoring ◽  
Scoring Tool ◽  
Hiv 1

scholarly journals Validation of a clinical risk-scoring algorithm for severe scrub typhus

2014 ◽  
pp. 29
Author(s):  
Sirianong Namwongprom ◽  
Pamornsri Sriwongpan ◽  
Jayanton Patumanond ◽  
Pornsuda Krittigamas ◽  
Hutsaya Tantipong ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Clinical Risk ◽  
Scoring Algorithm ◽  
Risk Scoring

scholarly journals A Novel Risk Scoring Tool to Predict Saphenous Vein Graft Occlusion in Patients with Type 2 Diabetes Mellitus After Cardiac Artery Bypass Graft Surgery

2020 ◽  
Author(s):  
Yujing Cheng ◽  
Xiaoteng Ma ◽  
Xiaoli Liu ◽  
Yingxin Zhao ◽  
Yan Sun ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Validation Cohort ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Graft Occlusion ◽  
Risk Scoring ◽  
Predictive Risk ◽  
Scoring Tool

Abstract Background: Coronary artery bypass grafting (CABG) success is reduced by graft occlusion. Patients with type 2 diabetes mellitus(T2DM) are more likely to develop graft occlusion. Understanding factors associated with graft occlusion may improve T2DM patient outcomes. The aim of this study was to develop a predictive risk score for saphenous vein graft (SVG) occlusion in T2DM patients after CABG.Methods: This retrospective cohort study enrolled 3716 CABG patients with T2DM from January 2012 to March 2013. The development cohort included 2477 patients and the validation cohort included 1239 patients. The baseline clinical data at index CABG was analyzed for their independent impact on graft occlusion in our study using Cox proportional hazards regression. The predictive risk scoring tool was weighted by beta coefficients from the final model. Concordance (c)-statistics and comparison of the predicted and observed probabilities of predicted risk were used for discrimination and calibration.Results: A total of 959 (25.8%) out of 3716 patients developed at least one SVG occlusion. Significant risk factors for occlusion were male sex, estimated glomerular filtration rate<90, smoking (currently), hyperuricemia, dyslipidemia, prior percutaneous coronary intervention (PCI), a rising number of lesion vessels, and SVG. On-pump surgery, and the use of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and calcium channel blockers (CCB) were protective factors. The risk scoring tool with 11 variables was developed from the derivation cohort, which delineated each patient into risk quartiles. The c-statistic for this model was 0.71 in the validation cohort.Conclusions: An easy-to-use risk scoring tool that used common clinical variables was developed and validated. The scoring tool accurately estimated the risk of late SVG occlusion in T2DM patients after CABG.

Effect of Replacing Vendor QTc Alerts with a Custom QTc Risk Alert in Inpatients

2022 ◽  
Vol 13 (01) ◽  
pp. 019-029
Author(s):  
Steven Stettner ◽  
Sarah Adie ◽  
Sarah Hanigan ◽  
Michael Thomas ◽  
Kristen Pogue ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Clinical Decision ◽  
Qtc Interval ◽  
Intervention Period ◽  
Qtc Prolongation ◽  
Post Intervention ◽  
Medication Knowledge ◽  
Quasi Experimental ◽  
Risk Scoring ◽  
Scoring Tool

Abstract Objective The aim of the study is to implement a customized QTc interval clinical decision support (CDS) alert strategy in our electronic health record for hospitalized patients and aimed at providers with the following objectives: minimize QTc prolongation, minimize exposure to QTc prolonging medications, and decrease overall QTc-related alerts. A strategy that was based on the validated QTc risk scoring tool and replacing medication knowledge vendor alerts with custom QTc prolongation alerts was implemented. Methods This is a retrospective quasi-experimental study with a pre-intervention period (August 2019 to October 2019) and post-intervention period (December 2019 to February 2020). The custom alert was implemented in November 2019. Results In the pre-implementation group, 361 (19.3%) patients developed QTc prolongation, and in the post-implementation group, 357 (19.6%) patients developed QTc prolongation (OR: 1.02, 95% CI: 0.87–1.20, p = 0.81). The odds ratio of an action taken post-implementation compared with pre-implementation was 18.90 (95% CI: 14.03–25.47, p <0. 001). There was also a decrease in total orders for QTc prolonging medications from 7,921 (5.5%) to 7,566 (5.3%) with an odds ratio of 0.96 (95% CI: 0.93–0.99, p = 0.01). Conclusion We were able to decrease patient exposure to QTc prolonging medications while not increasing the rate of QTc prolongation as well as improving alert action rate. Additionally, there was a decrease in QTc prolonging medication orders which illustrates the benefit of using a validated risk score with a customized CDS approach compared with a traditional vendor-based strategy. Further research is needed to confirm if an approach implemented at our organization can reduce QTc prolongation rates.

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