Validation of a Mortality Prediction Model for Acutely Decompensated Heart Failure Patients
Validation of a Mortality Prediction Model for Acutely Decompensated Heart Failure Patients
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.
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.
Inclusion Criteria:

 -  age 18 or older

 -  presentation to the Emergency Department and/or admission to the hospital with
 diagnosis of acute decompensated heart failure

 Exclusion Criteria:

 -  minors

 -  prisoners