Clinical Decision-Making, Rapid Follow-Up Lead to Lower Risk of Death From Heart Failure

The use of a hospital-based strategy that supports clinical decision making and rapid follow-up led to a lower risk of composite death from any cause or hospitalization from cardiovascular causes within 30 days among those with acute heart failure (HF), according to the results of a study published in The New England Journal of Medicine.

Investigators randomly assigned 10 hospitals to staggered start dates for patient crossover from usual care to the intervention phase. The intervention phase involved the use of point-of-care algorithm to separate individuals with acute HF according to the risk of death.

Low-risk individuals were discharged in 3 or less days during the intervention phase. They received standardized outpatient care while individuals who were high risk 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. The composite outcome was within 20 months.

Investigators included a total of 5452 individuals, with 2972 used during the control phase and 2480 during the intervention phase.

They found that within 30 days death from any cause or hospitalization from cardiovascular cases occurred in just 12% of individuals in the intervention phase and 14.5% in the control phase.

Additionally, the risk of hospitalization for cardiovascular causes and HF appeared to be lower during the intervention phase.

Death from any cause or hospitalizations for cardiovascular causes occurred in 36 lower-risk individuals in each group, 67 intermediate-risk patients in the intervention phase and 100 in the control phase, and 190 high-risk patients and 285, respectively.

Within 20 months, investigators found that the cumulative incidence of primary-outcome events was 54.4% and 56.2%, respectively. Fewer than 6 deaths or hospitalizations for any cause occurred in low- or intermediate-risk patients before the first outpatient visit within 30 days after discharge.

The median follow-up time was 280 days among those in the control phase and 144 individuals in the intervention phase.

Furthermore, the risk of serious adverse events occurring before the first outpatient visit within 30 days after discharge for patients in the intervention phase did not seem to be higher for those who were in the control phase.

No deaths or hospitalizations for any cause occurred in low- or intermediate-risk individuals within 7 days of the first outpatient visit.

Investigators also noted some limitations of the study, which limited their investigators’ ability to determine which aspects of complex intervention had the greatest impact.

Further, implementation of this approach could provide pathways in health systems for early and safe discharges and improve patient outcomes, they said.

The use of a point-of-care tool and rapid follow-up were essential to lower the risk of death from any cause and hospitalization from cardiovascular disease within 30 days after acute HF presentation than the standard of care, investigators noted.

Reference

Lee DS, Straus SE, Farkouh ME, Austin PC, et al. Trial of an intervention to improve acute heart failure outcomes. N Engl J Med. 2023;388(1):22-32. doi:10.1056/NEJMoa2211680