Lace Index: Predict the High-Risk of 30-Days Readmission of Patients With Acute Myocardial Infarction: National Health Insurance Claims Data 2011–2020

IF 2.1 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

Journal of evaluation in clinical practice Pub Date : 2025-09-30 DOI:10.1111/jep.70289

Vasuki Rajaguru, Whiejong Han, Suk-Yong Jang, Jaeyong Shin, Sang Gyu Lee, Tae Hyun Kim

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引用次数: 0

Abstract

Background

Readmission following acute myocardial infarction (AMI) poses significant challenges to health systems and patient outcomes. The LACE index, a composite of Length of stay, Acuity of admission, Comorbidities, and Emergency department visits, is widely used for readmission prediction. However, its performance in large-scale, real-world Korean cohorts remains understudied.

Objective

This study aimed to validate the predictive performance of the LACE index for 30-day readmissions in AMI patients using a nationally representative Korean cohort.

Methods

This retrospective cohort study analyzed data from the Korean National Health Insurance Service Sample (NHISS) database from 2011 to 2020. A total of 609,640 adult patients hospitalized for AMI were included. The LACE index was calculated for each patient, and 30-day readmissions were identified. Logistic regression was used to estimate odds ratios (ORs) for readmission. Model discrimination was assessed using ROC curve analysis and C-statistics. Subgroup and survival analyses were performed by age, LACE score, and comorbidity burden.

Results

Among 609,640 AMI patients, 205 (0.034%) experienced 30-day readmission. Patients with a LACE score of ≥ 10 had significantly higher odds of readmission (OR = 2.65; 95% CI: 1.68–4.19, p < 0.001) compared to those with scores 0–4. Middle-aged adults (35–64 years) also showed elevated readmission risk (OR = 3.42; 95% CI: 1.74–6.73, p < 0.001), while older adults (≥ 65 years) did not have significantly different risk. The LACE index showed moderate discriminatory performance (C-statistics = 0.71). Kaplan–Meier survival curves demonstrated significantly lower 30-day survival among patients with LACE ≥ 10.

Conclusions

Study findings suggest the LACE index is a useful tool for predicting 30-day readmissions among AMI patients in Korea. Its simplicity and moderate accuracy support its application in clinical and policy-level risk stratification strategies. Future prospective studies should refine prediction models by incorporating additional clinical variables.

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查看原文本刊更多论文

蕾丝指数：预测急性心肌梗死患者30天再入院的高风险：2011-2020年国民健康保险索赔数据。

背景：急性心肌梗死（AMI）后再入院对卫生系统和患者预后构成重大挑战。LACE指数是住院时间、入院锐度、合并症和急诊科就诊次数的综合指数，被广泛用于再入院预测。然而，它在大规模、真实的韩国队列中的表现仍有待研究。目的：本研究旨在通过具有全国代表性的韩国队列验证LACE指数对AMI患者30天再入院的预测性能。方法：本回顾性队列研究分析了2011年至2020年韩国国民健康保险服务样本（NHISS）数据库中的数据。共纳入609,640名因急性心肌梗死住院的成年患者。计算每位患者的LACE指数，并确定30天再入院。使用逻辑回归估计再入院的优势比（or）。采用ROC曲线分析和c统计量评估模型判别性。根据年龄、LACE评分和合并症负担进行亚组和生存分析。结果：609,640例AMI患者中，205例（0.034%）30天再入院。LACE评分≥10的患者再入院的几率明显更高（OR = 2.65; 95% CI: 1.68-4.19, p）结论：研究结果表明，LACE指数是预测韩国AMI患者30天再入院的有用工具。它的简单性和适度的准确性支持其在临床和政策层面的风险分层策略的应用。未来的前瞻性研究应通过纳入其他临床变量来完善预测模型。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of evaluation in clinical practice 医学-卫生保健

CiteScore

4.80

自引率

4.20%

发文量

143

审稿时长

3-8 weeks

期刊介绍： The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.