Vasuki Rajaguru, Whiejong Han, Suk-Yong Jang, Jaeyong Shin, Sang Gyu Lee, Tae Hyun Kim
{"title":"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。","authors":"Vasuki Rajaguru, Whiejong Han, Suk-Yong Jang, Jaeyong Shin, Sang Gyu Lee, Tae Hyun Kim","doi":"10.1111/jep.70289","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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, <i>p</i> < 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, <i>p</i> < 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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 7","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70289","citationCount":"0","resultStr":"{\"title\":\"Lace Index: Predict the High-Risk of 30-Days Readmission of Patients With Acute Myocardial Infarction: National Health Insurance Claims Data 2011–2020\",\"authors\":\"Vasuki Rajaguru, Whiejong Han, Suk-Yong Jang, Jaeyong Shin, Sang Gyu Lee, Tae Hyun Kim\",\"doi\":\"10.1111/jep.70289\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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, <i>p</i> < 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, <i>p</i> < 0.001), while older adults (≥ 65 years) did not have significantly different risk. The LACE index showed moderate discriminatory performance (C-statistics = 0.71). 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Lace Index: Predict the High-Risk of 30-Days Readmission of Patients With Acute Myocardial Infarction: National Health Insurance Claims Data 2011–2020
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.
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.
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