Trial of an Intervention to Improve Acute Heart Failure Outcomes | NEJM

In Health


Abstract

Background

Patients with acute heart failure are frequently or systematically hospitalized, often because the risk of adverse events is uncertain and the options for rapid follow-up are inadequate. Whether the use of a strategy to support clinicians in making decisions about discharging or admitting patients, coupled with rapid follow-up in an outpatient clinic, would affect outcomes remains uncertain.

Methods

In a stepped-wedge, cluster-randomized trial conducted in Ontario, Canada, we randomly assigned 10 hospitals to staggered start dates for one-way crossover from the control phase (usual care) to the intervention phase, which involved the use of a point-of-care algorithm to stratify patients with acute heart failure according to the risk of death. During the intervention phase, low-risk patients were discharged early (in ≤3 days) and received standardized outpatient care, and high-risk patients were admitted to the hospital. The coprimary outcomes were a composite of death from any cause or hospitalization for cardiovascular causes within 30 days after presentation and the composite outcome within 20 months.

Results

A total of 5452 patients were enrolled in the trial (2972 during the control phase and 2480 during the intervention phase). Within 30 days, death from any cause or hospitalization for cardiovascular causes occurred in 301 patients (12.1%) who were enrolled during the intervention phase and in 430 patients (14.5%) who were enrolled during the control phase (adjusted hazard ratio, 0.88; 95% confidence interval [CI], 0.78 to 0.99; P=0.04). Within 20 months, the cumulative incidence of primary-outcome events was 54.4% (95% CI, 48.6 to 59.9) among patients who were enrolled during the intervention phase and 56.2% (95% CI, 54.2 to 58.1) among patients who were enrolled during the control phase (adjusted hazard ratio, 0.95; 95% CI, 0.92 to 0.99). Fewer than six deaths or hospitalizations for any cause occurred in low- or intermediate-risk patients before the first outpatient visit within 30 days after discharge.

Conclusions

Among patients with acute heart failure who were seeking emergency care, the use of a hospital-based strategy to support clinical decision making and rapid follow-up led to a lower risk of the composite of death from any cause or hospitalization for cardiovascular causes within 30 days than usual care. (Funded by the Ontario SPOR Support Unit and others; COACH ClinicalTrials.gov number, NCT02674438.)



Read More: Trial of an Intervention to Improve Acute Heart Failure Outcomes | NEJM

Join Our Newsletter!

Love Daynight? We love to tell you about our new stuff. Subscribe to newsletter!

You may also read!

US VC firm Sequoia Capital sells 3.7% stake in Go Fashion for Rs 228 cr

American venture capital firm Sequoia Capital has sold 3.7% stake in apparel company Go Fashion through the open

Read More...

Creative Kids Group and Little Tikes® Expand Partnership to United Kingdom and Ireland

Sales for the iconic brand in wood form begin nowCHESTNUT RIDGE, N.Y. and LOS ANGELES, Dec. 5, 2022

Read More...

Supreme Court taking up clash of religion and gay rights

WASHINGTON (AP) — The Supreme Court is hearing the case Monday of a Christian graphic artist who objects

Read More...

Leave a reply:

Your email address will not be published.

Mobile Sliding Menu