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Sun LY, Wijeysundera HC, Lee DS, van Diepen S, Ruel M, Eddeen AB, Mesana TG. Derivation and validation of a clinical risk score to predict death among patients awaiting cardiac surgery in Ontario, Canada: a population-based study. CMAJ Open 2022; 10:E173-E182. [PMID: 35260467 PMCID: PMC9259465 DOI: 10.9778/cmajo.20210031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Surgical delay may result in unintended harm to patients needing cardiac surgery, who are at risk for death if their condition is left untreated. Our objective was to derive and internally validate a clinical risk score to predict death among patients awaiting major cardiac surgery. METHODS We used the CorHealth Ontario Registry and linked ICES health administrative databases with information on all Ontario residents to identify patients aged 18 years or more who were referred for isolated coronary artery bypass grafting (CABG), valvular procedures, combined CABG-valvular procedures or thoracic aorta procedures between Oct. 1, 2008, and Sept. 30, 2019. We used a hybrid modelling approach with the random forest method for initial variable selection, followed by backward stepwise logistic regression modelling for clinical interpretability and parsimony. We internally validated the logistic regression model, termed the CardiOttawa Waitlist Mortality Score, using 200 bootstraps. RESULTS Of the 112 266 patients referred for cardiac surgery, 269 (0.2%) died while awaiting surgery (118/72 366 [0.2%] isolated CABG, 81/24 461 [0.3%] valvular procedures, 63/12 046 [0.5%] combined CABG-valvular procedures and 7/3393 [0.2%] thoracic aorta procedures). Age, sex, surgery type, left main stenosis, Canadian Cardiovascular Society classification, left ventricular ejection fraction, heart failure, atrial fibrillation, dialysis, psychosis and operative priority were predictors of waitlist mortality. The model discriminated (C-statistic 0.76 [optimism-corrected 0.73]). It calibrated well in the overall cohort (Hosmer-Lemeshow p = 0.2) and across surgery types. INTERPRETATION The CardiOttawa Waitlist Mortality Score is a simple clinical risk model that predicts the likelihood of death while awaiting cardiac surgery. It has the potential to provide data-driven decision support for managing access to cardiac care and preserve system capacity during the COVID-19 pandemic, the recovery period and beyond.
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Affiliation(s)
- Louise Y Sun
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont.
| | - Harindra C Wijeysundera
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Douglas S Lee
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Sean van Diepen
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Marc Ruel
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Anan Bader Eddeen
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
| | - Thierry G Mesana
- Division of Cardiac Anesthesiology (Sun), University of Ottawa Heart Institute; School of Epidemiology and Public Health (Sun), University of Ottawa, Ottawa, Ont.; ICES (Sun, Wijeysundera, Lee, Eddeen); Schulich Heart Program (Wijeysundera), Sunnybrook Health Sciences Centre; Division of Cardiology (Wijeysundera), Department of Medicine, University of Toronto; Institute of Health Policy, Management and Evaluation (Wijeysundera), University of Toronto; Peter Munk Cardiac Centre (Lee), University Health Network, University of Toronto, Toronto, Ont.; Department of Critical Care Medicine (van Diepen), University of Alberta; Division of Cardiology (van Diepen), Department of Medicine, University of Alberta, Edmonton, Alta.; Division of Cardiac Surgery (Ruel, Mesana), University of Ottawa Heart Institute, Ottawa, Ont
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