Heart Failure, CongestiveNCT00536367
Validation of a Mortality Prediction Model for Acutely Decompensated Heart Failure Patients
An observational study of Heart Failure, Congestive, run by Brian Hiestand MD at 1 site in United States.
Trial summary
The purpose of this protocol is to determine if the 3 variable mortality prediction model established using data from a retrospective, multi-center patient registry (The ADHERE Acute Decompensated HEart FailuRE National Registry) will hold for a prospective, observational outcome study of OSU patients diagnosed in the… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Heart Failure, Congestive
- How many people
- 226 participants
- Where
- 1 siteUnited States
- Study dates
- Jan 2006to Mar 2008
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- age 18 or older
- presentation to the Emergency Department and/or admission to the hospital with diagnosis of acute decompensated heart failure
Who cannot join
- minors
- prisoners
Trial locations and contacts
1 site in 1 country.
United States1 site
The Ohio State University Medical Center
Columbus, Ohio, 43210
About this study
The purpose of this protocol is to determine if the 3 variable mortality prediction model established using data from a retrospective, multi-center patient registry (The ADHERE Acute Decompensated HEart FailuRE National Registry) will hold for a prospective, observational outcome study of OSU patients diagnosed in the Emergency Department (ED)with Acute Decompensated Heart Failure (ADHF). In the retrospective registry, three parameters were found to be highly predictive of inpatient mortality for patients admitted with ADHF - on admission, BUN > 43 mg/dL, systolic BP < 115 mmHg, and Cr > 2.75 mg/dL. However, the very nature of the ADHERE database limited the analytic potential of this model, as the data captured by ADHERE is retrospective and limited to the inpatient stay, and the only outcome evaluated was inpatient mortality. Due to its inherent limitations, the model did not and could not address longer term outcomes, such as repeat visits to the emergency department after discharge, or need for readmission to an acute care setting, which frequently occurs soon after discharge in patients who survive to discharge after being admitted with ADHF.
This observational study will create a registry of patient information obtained from an interview with the patient and a review of the patient's medical record. Follow up information at 30 days post discharge will be obtained by phone interview with the patient and a review of the patient's OSUMC visit history.
Most ED patients diagnosed with ADHF are admitted, as emergency physicians are aware that heart failure in general carries a very high mortality rate. However, as risk stratification for ADHF is a severely under researched area, it is not at all clear which patients with acutely decompensated heart failure will have a poor outcome in the short and intermediate term. With an improved understanding of the risk profile of our ADHF patients, more appropriate decision making and disposition assignment can be made.
Read the detailed description
Congestive heart failure (CHF) affects nearly 5 million people in the United States and is steadily increasing in prevalence. It is the single most expensive diagnosis for CMS in the United States, responsible for one million hospitalizations per year. There is a wealth of evidence based management strategies for the long term care of the patient with chronic, stable heart failure. Unfortunately, there is a dearth of evidence for the management of the patient with acutely decompensated heart failure. By way of illustration, the American College of Cardiology and the American Heart Association (ACC/AHA) issued a voluminous guideline for the management of chronic CHF; to date no recommendations for the management of ADHF have been issued by the ACC/AHA.
As this is an observational study, the experimental portion is solely data collection. The research team will not attempt to guide clinical care. Demographic data, vital signs at presentation, medical history, advance directive status, laboratory values on admission (BNP, BUN, Cr, troponin), use of intravenous vasoactive medications, laboratory values if discharged alive (discharge BNP, BUN, Cr), critical care utilization, final discharge diagnosis, and hospital length of stay will be collected. Patients will be contacted by phone at 30 days from initial presentation to assess survival, ED usage, and rehospitalization.
Specific Aim #1: We will evaluate the performance of the three factor model (BUN > 43 mg/dL, systolic blood pressure < 115 mmHg, Cr < 2.75 mg/dL) using a prospective cohort of all patients admitted with a primary diagnosis of ADHF to predict ICU utilization and hospital length of stay.
Specific Aim #2: We will test the ability of the model to predict an expanded combined endpoint of mortality, readmission to an Emergency Department, and readmission to an inpatient or observation setting within 30 days of presentation with ADHF.
Specific Aim #3: We will incorporate and test additional variables into the Fonarow model to derive a rule to predict the 30 day combined endpoint of death, readmission to an Emergency Department, and readmission to an inpatient or observation setting within 30 days of presentation with ADHF.
- Conditions
- Heart Failure, Congestive
- Being tested
- No intervention - observational study only
- Keywords
- Heart Failure, Congestive, Mortality Prediction Model
- Medical subject headings
- Heart Failure
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
No intervention - observational study onlyOther
| Study group | Role | What they receive |
|---|---|---|
| Patients seen for ADHF at OSUMC | Not described Receives: Other: No intervention - observational study only |
What is being measured
The primary outcome is the main question the study is designed to answer.
30 day admit rate
examination of 30 day recidivism for heart failure admission patients
Measured: 30 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Sep 2007 (estimated)
- Study startJan 2006
- Primary completionJul 2007
- Study completionMar 2008
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Heart Failure, CongestiveStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Time perspective
- Prospective
- Enrolment
- 226 participants (actual)
Sponsor and investigators
- Lead sponsor
- Brian Hiestand MD
- Sponsor type
- University, hospital or other
- Collaborators
- Emergency Medicine Foundation
- Responsible party
- Sponsor-investigator, Brian Hiestand MD, Ohio State University
- Investigators
- Brian C Hiestand, MD, MPH, Principal investigator, The Ohio State University Dept. of Emergency Medicine
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00536367
- Sponsor's protocol ID
- 2005H0241
- Status last verified
- Jun 2014
- First submitted
- 25 Sep 2007
- Last updated
- 12 Jun 2014
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 12 Jun 2014. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Validation of a Mortality Prediction Model for Acutely Decompensated Heart Failure Patients
- ClinicalTrials.gov ID
- NCT00536367
- Acronym / sponsor ID
- 2005H0241
- Conditions
- Heart Failure, Congestive
- Keywords
- Heart Failure, Congestive, Mortality Prediction Model
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 226 participants (actual)
- Lead sponsor
- Brian Hiestand MDUniversity, hospital or other
- Collaborators
- Emergency Medicine Foundation
- Study start
- Jan 2006
- Primary completion
- Jul 2007 (actual)
- Study completion
- Mar 2008 (actual)
- First posted
- 27 Sep 2007 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this protocol is to determine if the 3 variable mortality prediction model established using data from a retrospective, multi-center patient registry (The ADHERE Acute Decompensated HEart FailuRE National Registry) will hold for a prospective, observational outcome study of OSU patients diagnosed in the Emergency Department (ED)with Acute Decompensated Heart Failure (ADHF). In the retrospective registry, three parameters were found to be highly predictive of inpatient mortality for patients admitted with ADHF - on admission, BUN > 43 mg/dL, systolic BP < 115 mmHg, and Cr > 2.75 mg/dL. However, the very nature of the ADHERE database limited the analytic potential of this model, as the data captured by ADHERE is retrospective and limited to the inpatient stay, and the only outcome evaluated was inpatient mortality. Due to its inherent limitations, the model did not and could not address longer term outcomes, such as repeat visits to the emergency department after discharge, or need for readmission to an acute care setting, which frequently occurs soon after discharge in patients who survive to discharge after being admitted with ADHF.
This observational study will create a registry of patient information obtained from an interview with the patient and a review of the patient's medical record. Follow up information at 30 days post discharge will be obtained by phone interview with the patient and a review of the patient's OSUMC visit history.
Most ED patients diagnosed with ADHF are admitted, as emergency physicians are aware that heart failure in general carries a very high mortality rate. However, as risk stratification for ADHF is a severely under researched area, it is not at all clear which patients with acutely decompensated heart failure will have a poor outcome in the short and intermediate term. With an improved understanding of the risk profile of our ADHF patients, more appropriate decision making and disposition assignment can be made.
Detailed description
Congestive heart failure (CHF) affects nearly 5 million people in the United States and is steadily increasing in prevalence. It is the single most expensive diagnosis for CMS in the United States, responsible for one million hospitalizations per year. There is a wealth of evidence based management strategies for the long term care of the patient with chronic, stable heart failure. Unfortunately, there is a dearth of evidence for the management of the patient with acutely decompensated heart failure. By way of illustration, the American College of Cardiology and the American Heart Association (ACC/AHA) issued a voluminous guideline for the management of chronic CHF; to date no recommendations for the management of ADHF have been issued by the ACC/AHA.
As this is an observational study, the experimental portion is solely data collection. The research team will not attempt to guide clinical care. Demographic data, vital signs at presentation, medical history, advance directive status, laboratory values on admission (BNP, BUN, Cr, troponin), use of intravenous vasoactive medications, laboratory values if discharged alive (discharge BNP, BUN, Cr), critical care utilization, final discharge diagnosis, and hospital length of stay will be collected. Patients will be contacted by phone at 30 days from initial presentation to assess survival, ED usage, and rehospitalization.
Specific Aim #1: We will evaluate the performance of the three factor model (BUN > 43 mg/dL, systolic blood pressure < 115 mmHg, Cr < 2.75 mg/dL) using a prospective cohort of all patients admitted with a primary diagnosis of ADHF to predict ICU utilization and hospital length of stay.
Specific Aim #2: We will test the ability of the model to predict an expanded combined endpoint of mortality, readmission to an Emergency Department, and readmission to an inpatient or observation setting within 30 days of presentation with ADHF.
Specific Aim #3: We will incorporate and test additional variables into the Fonarow model to derive a rule to predict the 30 day combined endpoint of death, readmission to an Emergency Department, and readmission to an inpatient or observation setting within 30 days of presentation with ADHF.
Study design
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Patients seen for ADHF at OSUMC | – | Other: No intervention - observational study only |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- age 18 or older
- presentation to the Emergency Department and/or admission to the hospital with diagnosis of acute decompensated heart failure
Key exclusion criteria (2 listed)
- minors
- prisoners
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| No intervention - observational study only | Other | Patients seen for ADHF at OSUMC |
Primary outcome
30 day admit rate
Time frame: 30 days
examination of 30 day recidivism for heart failure admission patients
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Jun 2014.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Brian C Hiestand, MD, MPH principal investigator
The Ohio State University Dept. of Emergency Medicine
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Heart Failure, Congestive, run by Brian Hiestand MD at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 12 Jun 2014. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
30 day admit rate (time frame: 30 days). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jun 2014.