Systematic Review and Critical Appraisal of Prediction Models for Readmission in Coronary Artery Disease Patients: Assessing Current Efficacy and Future Directions

Yunhao Zhang,1 Xuejiao Zhu,1 Fuer Gao,1 Shulan Yang2 1College of Nursing, Hangzhou Normal University, Hangzhou, People’s Republic of China; 2Department of Nursing, Zhejiang Hospital, Hangzhou, People’s Republic of ChinaCorrespondence: Xuejiao Zhu, College of Nursing, Hangzhou Normal University, Hangzhou, 311121, People’s Republic of China, Email jj_ice@163.comPurpose: Coronary artery disease (CAD) patients frequently face readmissions due to suboptimal disease management. Prediction models are pivotal for detecting early unplanned readmissions. This review offers a unified assessment, aiming to lay the groundwork for enhancing prediction models and informing prevention strategies.Methods: A search through five databases (PubMed, Web of Science, EBSCOhost, Embase, China National Knowledge Infrastructure) up to September 2023 identified studies on prediction models for coronary artery disease patient readmissions for this review. Two independent reviewers used the CHARMS checklist for data extraction and the PROBAST tool for bias assessment.Results: From 12,457 records, 15 studies were selected, contributing 30 models targeting various CAD patient groups (AMI, CABG, ACS) from primarily China, the USA, and Canada. Models utilized varied methods such as logistic regression and machine learning, with performance predominantly measured by the c-index. Key predictors included age, gender, and hospital stay duration. Readmission rates in the studies varied from 4.8% to 45.1%. Despite high bias risk across models, several showed notable accuracy and calibration.Conclusion: The study highlights the need for thorough external validation and the use of the PROBAST tool to reduce bias in models predicting readmission for CAD patients.Keywords: coronary artery disease, readmission, prediction model, systematic review