{"id":1753,"date":"2022-11-05T00:00:00","date_gmt":"2022-11-05T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/"},"modified":"2023-11-30T14:15:56","modified_gmt":"2023-11-30T19:15:56","slug":"trial-of-an-intervention-to-improve-acute-heart-failure-outcomes","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/","title":{"rendered":"Trial of an intervention to improve acute heart failure outcomes"},"content":{"rendered":"<p><strong>Background<\/strong> &#x2014; 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.<\/p>\n<p><strong>Methods<\/strong> &#x2014; 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 &#x2264;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.<\/p>\n<p><strong>Results<\/strong> &#x2014; 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.<\/p>\n<p><strong>Conclusions<\/strong> &#x2014; 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.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014; 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 [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[66],"migration-helper-qa-sample-set":[],"class_list":["post-1753","journal_article","type-journal_article","status-publish","hentry","topic-trials"],"acf":{"citation":"Lee DS, Straus SE, Farkouh ME, Austin PC, Taljaard M, Chong A, Fahim C, Poon S, Cram P, Smith S, McKelvie RS, Porepa L; for the COACH Trial Investigators. <em>N Engl J Med. <\/em>2023; 388(1):22-32. Epub 2022 Nov 5.","source_url":"https:\/\/doi.org\/10.1056\/NEJMoa2211680","ices_scientist":[1385,1290,1187],"site":[6733],"research_program":[6742],"news_release":[7396],"journal_article":"","atlas":"","research_report":"","infographic":[9278],"video":"","downloads":null,"links":null,"sitecore_item_id":"FB8C9E89-CAA0-433B-8730-454486933877","sitecore_item_name":"Trial-of-an-intervention-to-improve-acute-heart-failure-outcomes","sitecore_field_values":"{\n  \"Title\": \"Trial of an intervention to improve acute heart failure outcomes\",\n  \"Short title\": \"Trial of an intervention to improve\",\n  \"Summary\": \"This study found that in patients with heart failure seeking emergency care, the use of a hospital-based strategy to support clinical decision making led to a lower risk of the composite of death.\",\n  \"Citation\": \"<p>Lee DS, Straus SE, Farkouh ME, Austin PC, Taljaard M, Chong A, Fahim C, Poon S, Cram P, Smith S, McKelvie RS, Porepa L; for the COACH Trial Investigators. <em>N Engl J Med. <\/em>2022; Nov 5 [Epub ahead of print]. DOI: <a href=\"https:\/\/doi.org\/10.1056\/NEJMoa2211680\" title=\"opens external link\">https:\/\/doi.org\/10.1056\/NEJMoa2211680<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Background<\/strong> &mdash; 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.<\/p>n<p><strong>Methods<\/strong> &mdash; 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 &le;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.<\/p>n<p><strong>Results<\/strong> &mdash; 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.<\/p>n<p><strong>Conclusions<\/strong> &mdash; 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.<\/p>\",\n  \"Research Programs\": \"{BEC72DE0-BA8C-42B8-ACE5-EE29FFB2CB3B}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{7D498E8B-5801-4F9E-AC41-11ED50F3C34E}|{CEEE13AD-C7DE-455F-ACF8-AAD7D27BB178}|{4DDEBA66-6CEA-43A8-83C3-6D1BDA5E9573}\",\n  \"Posted Date\": \"20221105T000000\",\n  \"Show on Publications Landing Page\": \"1\",\n  \"In The News\": \"{8249E18C-8DE7-4AB2-A5F0-93061E81A504}\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2022\/November\/Trial-of-an-intervention-to-improve-acute-heart-failure-outcomes"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Trial of an intervention to improve acute heart failure outcomes<\/title>\n<meta name=\"description\" content=\"Background &#x2014; Patients with acute heart failure are frequently or systematically hospitalized, often because the risk of adverse events is uncertain\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | Trial of an intervention to improve acute heart failure outcomes\" \/>\n<meta property=\"og:description\" content=\"Background &#x2014; Patients with acute heart failure are frequently or systematically hospitalized, often because the risk of adverse events is uncertain\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/\" \/>\n<meta property=\"og:site_name\" content=\"ICES\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ICESOntario\/\" \/>\n<meta property=\"article:modified_time\" content=\"2023-11-30T19:15:56+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\\\/\",\"name\":\"ICES | Trial of an intervention to improve acute heart failure outcomes\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\"},\"datePublished\":\"2022-11-05T04:00:00+00:00\",\"dateModified\":\"2023-11-30T19:15:56+00:00\",\"description\":\"Background &#x2014; Patients with acute heart failure are frequently or systematically hospitalized, often because the risk of adverse events is uncertain\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\\\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Journal Articles\",\"item\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Trial of an intervention to improve acute heart failure outcomes\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/\",\"name\":\"ICES\",\"description\":\"POPULATION-BASED HEALTH RESEARCH THAT MAKES A DIFFERENCE\",\"publisher\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#organization\"},\"alternateName\":\"Institute for Clinical Evaluative Sciences\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#organization\",\"name\":\"ICES\",\"alternateName\":\"Institute for Clinical Evaluative Sciences\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/wp-content\\\/uploads\\\/2023\\\/04\\\/ices-logo.png\",\"contentUrl\":\"https:\\\/\\\/www.ices.on.ca\\\/wp-content\\\/uploads\\\/2023\\\/04\\\/ices-logo.png\",\"width\":\"676\",\"height\":\"618\",\"caption\":\"ICES\"},\"image\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/ICESOntario\\\/\",\"https:\\\/\\\/www.linkedin.com\\\/company\\\/ices-research-institute\\\/\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"ICES | Trial of an intervention to improve acute heart failure outcomes","description":"Background &#x2014; Patients with acute heart failure are frequently or systematically hospitalized, often because the risk of adverse events is uncertain","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/","og_locale":"fr_FR","og_type":"article","og_title":"ICES | Trial of an intervention to improve acute heart failure outcomes","og_description":"Background &#x2014; Patients with acute heart failure are frequently or systematically hospitalized, often because the risk of adverse events is uncertain","og_url":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/","og_site_name":"ICES","article_publisher":"https:\/\/www.facebook.com\/ICESOntario\/","article_modified_time":"2023-11-30T19:15:56+00:00","og_image":[{"width":1200,"height":675,"url":"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg","type":"image\/jpeg"}],"twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/","url":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/","name":"ICES | Trial of an intervention to improve acute heart failure outcomes","isPartOf":{"@id":"https:\/\/www.ices.on.ca\/fr\/#website"},"datePublished":"2022-11-05T04:00:00+00:00","dateModified":"2023-11-30T19:15:56+00:00","description":"Background &#x2014; Patients with acute heart failure are frequently or systematically hospitalized, often because the risk of adverse events is uncertain","breadcrumb":{"@id":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/#breadcrumb"},"inLanguage":"fr-FR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/trial-of-an-intervention-to-improve-acute-heart-failure-outcomes\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.ices.on.ca\/fr\/"},{"@type":"ListItem","position":2,"name":"Journal Articles","item":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/"},{"@type":"ListItem","position":3,"name":"Trial of an intervention to improve acute heart failure outcomes"}]},{"@type":"WebSite","@id":"https:\/\/www.ices.on.ca\/fr\/#website","url":"https:\/\/www.ices.on.ca\/fr\/","name":"ICES","description":"POPULATION-BASED HEALTH RESEARCH THAT MAKES A DIFFERENCE","publisher":{"@id":"https:\/\/www.ices.on.ca\/fr\/#organization"},"alternateName":"Institute for Clinical Evaluative Sciences","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.ices.on.ca\/fr\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"fr-FR"},{"@type":"Organization","@id":"https:\/\/www.ices.on.ca\/fr\/#organization","name":"ICES","alternateName":"Institute for Clinical Evaluative Sciences","url":"https:\/\/www.ices.on.ca\/fr\/","logo":{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/www.ices.on.ca\/fr\/#\/schema\/logo\/image\/","url":"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2023\/04\/ices-logo.png","contentUrl":"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2023\/04\/ices-logo.png","width":"676","height":"618","caption":"ICES"},"image":{"@id":"https:\/\/www.ices.on.ca\/fr\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/ICESOntario\/","https:\/\/www.linkedin.com\/company\/ices-research-institute\/"]}]}},"_links":{"self":[{"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/journal_article\/1753","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/journal_article"}],"about":[{"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/types\/journal_article"}],"acf:post":[{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/infographic\/9278"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/news_release\/7396"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/research_program\/6742"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/site\/6733"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/ices_scientist\/1187"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/ices_scientist\/1290"},{"embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/ices_scientist\/1385"}],"wp:attachment":[{"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/media?parent=1753"}],"wp:term":[{"taxonomy":"migration-helper-automated","embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/migration-helper-automated?post=1753"},{"taxonomy":"migration-manual","embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/migration-manual?post=1753"},{"taxonomy":"topic","embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/topic?post=1753"},{"taxonomy":"migration-helper-qa-sample-set","embeddable":true,"href":"https:\/\/www.ices.on.ca\/fr\/wp-json\/wp\/v2\/migration-helper-qa-sample-set?post=1753"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}