Toronto, ON, November 5, 2022 – A tool that emergency department clinicians can use to guide hospital admission or discharge decisions for heart failure patients reduces 30-day all-cause death or cardiovascular hospitalization by 12 per cent, according to a new trial from the Peter Munk Cardiac Centre (PMCC) at University Health Network (UHN), ICES, and the Ted Rogers Centre for Heart Research.
The validated tool, which was developed using data analytics, helps hospital staff to ascertain whether heart failure patients fall into low-, intermediate-, or high-risk categories, which can then inform the decision to admit a patient to hospital or discharge with follow-up care.
The randomized trial, published in the New England Journal of Medicine, included 10 hospitals and 5,452 patients in Ontario, Canada, and assigned hospitals to usual care (when clinicians use their clinical judgement to guide decisions) followed by a cross-over to the use of the tool. The study was made possible through funding from the Ontario SPOR SUPPORT Unit (OSSU).
The study comes as hospitals grapple with overcrowding and staffing shortages and suggests that heart failure patients at lower risk of adverse events can be discharged from the emergency department or following a short hospital stay—with rapid follow-up care in place.
"Heart failure places a substantial health burden on patients and increases healthcare utilization and costs," says lead author Dr. Douglas Lee, staff cardiologist at the Peter Munk Cardiac Centre at UHN, Ted Rogers Chair in Heart Function Outcomes at the Ted Rogers Centre for Heart Research (TRCHR), and Senior Scientist at ICES. "We need new approaches to improve the care that we deliver to patients with heart failure who come to the emergency department, and the strategy that we tested may be a step toward achieving this goal."
The tool is used to support clinicians’ decision-making about who should be hospitalized and who can be discharged home early, with provision of a rapid follow-up visit at a clinic staffed by a nurse and supervised by a cardiologist.
Researchers found that the hospital-based strategy for decision support was associated with:
- A 12 per cent reduction in the rate of all-cause death or cardiovascular hospitalization over 30 days.
- A decrease in the rate death or cardiovascular hospitalization over a 20-month follow-up.
- Fewer than six deaths or all-cause hospitalizations for low-risk and intermediate-risk patients who were discharged from hospital until they could be seen by a doctor in the outpatient clinic.
“It has always been our goal to ensure that we provide the right care, for the right patient, at the right time,” says senior author Dr. Heather Ross, Scientific Lead, Ted Rogers Centre for Heart Research, and division head, Cardiology, at the Peter Munk Cardiac Centre at the University Health Network. “This diagnostic tool will have an immense impact, not just on patients and families, but on the whole of the healthcare system.”
The study, “Trial of an Intervention to Improve Acute Heart Failure Outcomes” was published in the New England Journal of Medicine. The study was supported by ICES and was funded by the Ontario SPOR Support Unit, the Ted Rogers Centre for Heart Research, and the Canadian Institutes of Health Research.
Author block: Lee DS, Straus SE, Farkouh ME, Austin PC, Taljaard M, Chong A, Fahim C, Poon S, Peter Cram P, Smith S, McKelvie RS, Porepa L, Hartleib M, Mitoff P, Iwanochko RM, MacDougall A, Shadowitz S, H Abrams, Elbarasi E, Fang J, Udell JA, Schull MJ, Mak S, Ross HJ, on behalf of the COACH Trial investigators
The Peter Munk Cardiac Centre (PMCC) opened in 1997 through the generous support of Peter and Melanie Munk. A global leader in cardiovascular care, with internationally-renown medical expertise, PMCC has some of the best patient outcomes in the world and is home to many world firsts that span cardiac and vascular research and discoveries. Canada's premier cardiac centre is part of the University Health Network (UHN) and located at the Toronto General Hospital, and the Toronto Western Hospital, in Toronto, Ontario, Canada. For more information, visit: www.petermunkcardiaccentre.ca
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
The Ted Rogers Centre for Heart Research, founded in 2014, has the mission is to transform and dramatically improve the future of heart health for children, adults and families across Canada and around the world, through an integrated program of outstanding research, education, and clinical care. At the Ted Rogers Centre for Heart Research, pre-eminent experts in a variety of disciplines including cardiology, bioengineering, computer science, cell biology, pediatrics, nursing, genomic medicine, and immunology work together to accelerate the discovery of new approaches to treating heart failure. A model for collaborative medicine, it has reaffirmed Toronto as a global hub for cutting-edge cardiovascular research. www.tedrogersresearch.ca
New England Journal of Medicine
Method of Research
Randomized controlled/clinical trial
Subject of Research
Trial of an Intervention to Improve Acute Heart Failure Outcomes
Article Publication Date