“It’s very hard to tell which patients with acute heart failure are at risk of complications. With this tool, care can be personalized based on their level of risk,” -Dr. Monica TaljaardA clinical decision tool used in the emergency department can improve outcomes for patients with acute heart failure, according to trial involving more than 5,000 patients, published in the New England Journal of Medicine.
Acute heart failure is a life-threatening emergency. The heart is still pumping, but the rapid decline in heart function causes shortness of breath and can lead to severe complications and death. Because a patient’s risk of complications is unknown, they are often hospitalized so they can be monitored.
In this stepped-wedge cluster-randomized trial, physicians in emergency departments in 10 Ontario hospitals used a clinical decision tool to calculate the risk of death for patients with acute heart failure. Low-risk patients were discharged in less than three days and received outpatient care, while high-risk patients were admitted to hospital.
During the period in which the decision tool was used, 12.1% of patients with acute heart failure died or were hospitalized for cardiovascular reasons within 30 days, compared to 14.5% of patients in the period when the tools were was not used – a significant difference.
Dr. Monica Taljaard was a co-author on the study, and provided input on the stepped-wedge, cluster-randomized trial design.
“It’s very hard to tell which patients with acute heart failure are at risk of complications. With this tool, care can be personalized based on their level of risk,” said Dr. Monica Taljaard, senior scientist at The Ottawa Hospital and professor at the University of Ottawa.
Authors: Douglas S. Lee, Sharon E. Straus, Michael E. Farkouh, Peter C. Austin, Monica Taljaard, Alice Chong, Christine Fahim, Stephanie Poon, Peter Cram, Stuart Smith, Robert S. McKelvie, Liane Porepa, et al., for the COACH Trial Investigators.
Funding: This research was funded by the Ontario SPOR (Strategy for Patient-Oriented Research) Support Unit, the Ted Rogers Centre for Heart Research, the Peter Munk Cardiac Centre, Canadian Institutes of Health Research, and ICES. All research at The Ottawa Hospital is also enabled by generous donations to The Ottawa Hospital Foundation.
The Ottawa Hospital is a leading academic health, research and learning hospital proudly affiliated with the University of Ottawa and supported by The Ottawa Hospital Foundation.
