Despite the availability of effective therapies, patients hospitalized for heart failure (HF) are plagued by high rates of adverse events including hospital readmissions and one-year mortality risks. The cause for these adverse outcomes, according to a study published in JACC: Heart Failure, is the gap between prognostic information and clinical decision making. The REVeAL-HF (Risk Evaluation and its Impact on Clinical Decision Making and Outcomes in Heart Failure) trial assessed whether provision of mortality estimates impacted clinical decision-making and outcomes in hospitalized patients with heart failure.
“Within the universe of heart failure, innumerable risk scores have been developed, but no one has studied their impact on clinical decision-making in a randomized clinical trial,” said Tariq Ahmad MD, MPH, an associate professor and Interim Chief of Heart Failure at Yale. Ahmad will be presenting results from the trial at the American Heart Association Scientific Sessions late-breaking science session, “Information Overload? Striving to Improve Care Delivery through Digital Health and Automated Data,” on Sunday, November 14 at 2:45 p.m.
REVeAL-HF is the first randomized controlled clinical trial to examine how prognostic indicators in heart failure influence clinical decision-making. By analyzing the risks and benefits of different treatment options, the aim is to provide physicians with individualized treatment recommendations. Ahmad developed the risk prediction algorithm in collaboration with Nihar Desai, MD, MPH, F. Perry Wilson, MD, MSCE, and investigators at Yale School of Medicine and the Yale Center for Clinical Investigation.
“With Perry’s help, we created and validated algorithms based on patients from within the Yale Health System that predict risk of inpatient and one-year mortality with a very high degree of sensitivity and specificity. Then, with the help of our incredible colleagues who lead medical informatics, Nitu Kashyap, MD, and Allen Hsiao, MD, we were able to embed the algorithms within the structure of a randomized clinical trial. Finally, we are able to get weekly results with the help of the Yale Center for Clinical Investigation. It has truly been the best kind of team science and a blueprint for pragmatic clinical trials at Yale,” Ahmad said.