Development and Validation of a Machine Learning Score for Readmissions After Transcatheter Aortic Valve Implantation.

Background: Identifying predictors of readmissions after transcatheter aortic valve implantation (TAVI) is an important unmet need.
Objectives: We sought to explore the role of machine learning (ML) in predicting readmissions after TAVI.
Methods: We included patients who underwent TAVI between 2016 and 2019 in the Nationwide Readmission Database. A total of 917 candidate predictors representing all International Classification of Diseases, Tenth Revision, diagnosis and procedure codes were included. First, we used lasso regression to remove noninformative variables and rank informative ones. Next, we used an unsupervised ML model (K-means) to identify patterns/clusters in the data. Furthermore, we used Light Gradient Boosting Machine and Shapley Additive exPlanations to specify the impact of individual predictors. Finally, we built a parsimonious model to predict 30-day readmission.
Results: A total of 117,398 and 93,800 index TAVI hospitalizations were included in the 30- and 90-day analyses, respectively. Lasso regression identified 138 and 199 informative predictors for the 30- and 90-day readmission, respectively. Next, K-means recognized 2 distinct clusters: low risk and high risk. In the 30-day cohort, the readmission rate was 10.1% in the low risk group and 23.3% in the high risk group. In the 90-day cohort, the rates were 17.4% and 35.3%, respectively. The top predictors were the length of stay, frailty score, total discharge diagnoses, acute kidney injury, and Elixhauser score. These predictors were incorporated into a risk score (TAVI readmission score), which exhibited good performance in an external validation cohort (area under the curve 0.74 [0.7-0.78]).
Conclusions: ML methods can leverage widely available administrative databases to identify patients at risk for readmission after TAVI, which could inform and improve post-TAVI care.
Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.PERSPECTIVESCOMPETENCY IN PRACTICE-BASED LEARNING AND IMPROVEMENT: This study analyzed transcatheter aortic valve replacement readmissions on a national level and recognized clinically relevant patterns. Furthermore, we transformed our findings into a simple score that can be incorporated into electronic medical records and, therefore, be widely applicable by individual clinicians. TRANSLATIONAL OUTLOOK: Prospective validation in a larger cohort would be the next step in corroborating the suggested score. In addition, future studies would be needed to compare different interventions to prevent readmission using this score.
(© 2022 The Authors.)