Risk stratification in acute heart failure

Rationale and design of the STRATIFY and DECIDE studies

Sean P. Collins, Christopher J. Lindsell, Cathy A. Jenkins, Frank E. Harrell, Gregory J. Fermann, Karen F. Miller, Sue N. Roll, Matthew I. Sperling, David J. Maron, Allen J. Naftilan, John A. McPherson, Neal Lee Weintraub, Douglas B. Sawyer, Alan B. Storrow

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: A critical challenge for physicians facing patients presenting with signs and symptoms of acute heart failure (AHF) is how and where to best manage them. Currently, most patients evaluated for AHF are admitted to the hospital, yet not all warrant inpatient care. Up to 50% of admissions could be potentially avoided and many admitted patients could be discharged after a short period of observation and treatment. Methods for identifying patients that can be sent home early are lacking. Improving the physician's ability to identify and safely manage low-risk patients is essential to avoiding unnecessary use of hospital beds. Methods: Two studies (STRATIFY and DECIDE) have been funded by the National Heart Lung and Blood Institute with the goal of developing prediction rules to facilitate early decision making in AHF. Using prospectively gathered evaluation and treatment data from the acute setting (STRATIFY) and early inpatient stay (DECIDE), rules will be generated to predict risk for death and serious complications. Subsequent studies will be designed to test the external validity, utility, generalizability and cost-effectiveness of these prediction rules in different acute care environments representing racially and socioeconomically diverse patient populations. Results: A major innovation is prediction of 5-day as well as 30-day outcomes, overcoming the limitation that 30-day outcomes are highly dependent on unpredictable, post-visit patient and provider behavior. A novel aspect of the proposed project is the use of a comprehensive cardiology review to correctly assign post-treatment outcomes to the acute presentation. Conclusions: Finally, a rigorous analysis plan has been developed to construct the prediction rules that will maximally extract both the statistical and clinical properties of every data element. Upon completion of this study we will subsequently externally test the prediction rules in a heterogeneous patient cohort.

Original languageEnglish (US)
Pages (from-to)825-834
Number of pages10
JournalAmerican Heart Journal
Volume164
Issue number6
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

Fingerprint

Heart Failure
Inpatients
National Heart, Lung, and Blood Institute (U.S.)
Physicians
Aptitude
Cardiology
Signs and Symptoms
Cost-Benefit Analysis
Decision Making
Observation
Therapeutics
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Collins, S. P., Lindsell, C. J., Jenkins, C. A., Harrell, F. E., Fermann, G. J., Miller, K. F., ... Storrow, A. B. (2012). Risk stratification in acute heart failure: Rationale and design of the STRATIFY and DECIDE studies. American Heart Journal, 164(6), 825-834. https://doi.org/10.1016/j.ahj.2012.07.033

Risk stratification in acute heart failure : Rationale and design of the STRATIFY and DECIDE studies. / Collins, Sean P.; Lindsell, Christopher J.; Jenkins, Cathy A.; Harrell, Frank E.; Fermann, Gregory J.; Miller, Karen F.; Roll, Sue N.; Sperling, Matthew I.; Maron, David J.; Naftilan, Allen J.; McPherson, John A.; Weintraub, Neal Lee; Sawyer, Douglas B.; Storrow, Alan B.

In: American Heart Journal, Vol. 164, No. 6, 01.12.2012, p. 825-834.

Research output: Contribution to journalArticle

Collins, SP, Lindsell, CJ, Jenkins, CA, Harrell, FE, Fermann, GJ, Miller, KF, Roll, SN, Sperling, MI, Maron, DJ, Naftilan, AJ, McPherson, JA, Weintraub, NL, Sawyer, DB & Storrow, AB 2012, 'Risk stratification in acute heart failure: Rationale and design of the STRATIFY and DECIDE studies', American Heart Journal, vol. 164, no. 6, pp. 825-834. https://doi.org/10.1016/j.ahj.2012.07.033
Collins SP, Lindsell CJ, Jenkins CA, Harrell FE, Fermann GJ, Miller KF et al. Risk stratification in acute heart failure: Rationale and design of the STRATIFY and DECIDE studies. American Heart Journal. 2012 Dec 1;164(6):825-834. https://doi.org/10.1016/j.ahj.2012.07.033
Collins, Sean P. ; Lindsell, Christopher J. ; Jenkins, Cathy A. ; Harrell, Frank E. ; Fermann, Gregory J. ; Miller, Karen F. ; Roll, Sue N. ; Sperling, Matthew I. ; Maron, David J. ; Naftilan, Allen J. ; McPherson, John A. ; Weintraub, Neal Lee ; Sawyer, Douglas B. ; Storrow, Alan B. / Risk stratification in acute heart failure : Rationale and design of the STRATIFY and DECIDE studies. In: American Heart Journal. 2012 ; Vol. 164, No. 6. pp. 825-834.
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