Contemporary outpatient management of patients with worsening heart failure with reduced ejection fraction: Rationale and design of the CHART-HF study

Greene, Stephen J.; Lautsch, Dominik; Gaggin, Hanna K.; Djatche, Laurence; Zhou, Mo; Song, Yan; Signorovitch, James; Stevenson, Andrá S.; Blaustein, Robert O.; Butler, Javed

doi:10.1016/j.ahj.2022.05.016

Cited by 7 publications

(10 citation statements)

References 37 publications

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“…This provides further evidence to support the validity of outpatient WHF as a clinical entity and raises the hypothesis that this end point may be a potential target for evaluating HF therapies. 32 , 33 , 34 , 35 , 36 , 37 Interestingly, although HF is a heterogeneous condition and the traditional paradigm has underscored the diagnostic, prognostic, and therapeutic implications of an LVEF‐based classification system, we found that prediction models had similar performance with shared risk factors for WHF events across the LVEF spectrum. 38 , 39 The most important risk factors were all markers of volume status/fluid management highlighting the central role congestion plays in the pathophysiology of WHF, regardless of LVEF.…”

Section: Discussionmentioning

confidence: 74%

Developing Clinical Risk Prediction Models for Worsening Heart Failure Events and Death by Left Ventricular Ejection Fraction

Parikh,

Go,

Bhatt

et al. 2023

JAHA

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Background There is a need to develop electronic health record–based predictive models for worsening heart failure (WHF) events across clinical settings and across the spectrum of left ventricular ejection fraction (LVEF). Methods and Results We studied adults with heart failure (HF) from 2011 to 2019 within an integrated health care delivery system. WHF encounters were ascertained using natural language processing and structured data. We conducted boosted decision tree ensemble models to predict 1‐year hospitalizations, emergency department visits/observation stays, and outpatient encounters for WHF and all‐cause death within each LVEF category: HF with reduced ejection fraction (EF) (LVEF <40%), HF with mildly reduced EF (LVEF 40%–49%), and HF with preserved EF (LVEF ≥50%). Model discrimination was evaluated using area under the curve and calibration using mean squared error. We identified 338 426 adults with HF: 61 045 (18.0%) had HF with reduced EF, 49 618 (14.7%) had HF with mildly reduced EF, and 227 763 (67.3%) had HF with preserved EF. The 1‐year risks of any WHF event and death were, respectively, 22.3% and 13.0% for HF with reduced EF, 17.0% and 10.1% for HF with mildly reduced EF, and 16.3% and 10.3% for HF with preserved EF. The WHF model displayed an area under the curve of 0.76 and mean squared error of 0.13, whereas the model for death displayed an area under the curve of 0.83 and mean squared error of 0.076. Performance and predictors were similar across WHF encounter types and LVEF categories. Conclusions We developed risk prediction models for 1‐year WHF events and death across the LVEF spectrum using structured and unstructured electronic health record data and observed no substantial differences in model performance or predictors except for death, despite differences in underlying HF cause.

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Section: Discussionmentioning

confidence: 74%

Developing Clinical Risk Prediction Models for Worsening Heart Failure Events and Death by Left Ventricular Ejection Fraction

Parikh,

Go,

Bhatt

et al. 2023

JAHA

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“…An additional example of a retrospective WHF registry is the CHART–HF study. The purpose of this recent initiated registry is to evaluate the use of GDMT and to address the barriers towards GDMT in the WHF with reduced ejection fraction (EF) 22 …”

Section: Discussionmentioning

confidence: 99%

“…The purpose of this recent initiated registry is to evaluate the use of GDMT and to address the barriers towards GDMT in the WHF with reduced ejection fraction (EF). 22 For risk stratification, it is important to disentangle WHF from acute HF (AHF) as AHF encompasses both the first manifestation of NOHF and acute decompensated CHF. 2 The latter is used synonymously for WHF in the above-mentioned AHF registries.…”

Section: Discussionmentioning

confidence: 99%

Regional management of worsening heart failure: rationale and design of the CHAIN‐HF registry

et al. 2023

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Aims Heart failure (HF) is a progressive disease in which periods of clinical stability are interrupted by episodes of clinical deterioration known as worsening heart failure (WHF). Patients who develop WHF are at high risk of subsequent death, rehospitalization, and excessive healthcare costs. As such, WHF could be seen as a separate disease stage and precursor of advanced HF. Whether WHF has a substantial health, societal, and economic impact evidence regarding its multifactorial nature and the specific barriers in treatment, including advanced HF therapies, remains scarce. The CHAIN‐HF registry aims to describe the incidence, characteristics, current treatment, and outcomes of WHF. Additionally, it will promote structured regional collaboration and educate on increasing awareness for WHF and describe the implementation of guideline directed medical therapy and utilization of advanced HF therapies in a collaborative network. Methods and results The CHAIN‐HF registry is a prospective, observational, and multicentre study from the collaborating hospitals (Rijnmond HF Network) in the Rotterdam area. Unselected and consecutive patients (irrespective of ejection fraction) with a WHF event will be included. Comprehensive data including demographics, co‐morbidities, treatment, and in‐hospital and post‐discharge outcomes will be collected. Notably, data on socio‐economic status, treatment decisions, and referral for advanced HF therapies will be included. Conclusions CHAIN‐HF will be the first prospective, dedicated WHF registry in a collaborative network of hospitals that will provide robust real‐world evidence on the incidence, characteristics, and outcomes of WHF. Moreover, it will provide information on of the value of regional collaboration to improve awareness and outcomes of WHF.

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“…One such study design may include clinicians retrospectively reviewing the charts of HF patients directly under their care. 14 While medical record documentation can be extracted by anyone, having clinicians audit their own patient cases offers the potential for the treating clinician to fill gaps in documentation with their own memory and judgement of the patient encounter, and best understand why that clinician on that day did not prescribe GDMT. Such study designs directly engaging clinicians may also be able to determine if sub-target GDMT doses are believed to be maximally tolerated or not, which is central to distinguishing whether a sub-target dose of GDMT is guideline concordant versus gap in care.…”

Section: Understanding the 'Why' And 'Why Not' Of Real-world Guidelin...mentioning

confidence: 99%

“…To circumvent these data collection issues, novel study designs and data sources are needed to truly understand the reasons clinicians do not prescribe GDMT to seemingly eligible patients. One such study design may include clinicians retrospectively reviewing the charts of HF patients directly under their care 14 . While medical record documentation can be extracted by anyone, having clinicians audit their own patient cases offers the potential for the treating clinician to fill gaps in documentation with their own memory and judgement of the patient encounter, and best understand why that clinician on that day did not prescribe GDMT.…”

Section: Understanding the ‘Why’ And ‘Why Not’ Of Real‐world Guidelin...mentioning

confidence: 99%

Why do clinicians not prescribe quadruple medical therapy for heart failure with reduced ejection fraction?

Greene,

Khan,

Butler

2024

European J of Heart Fail

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Contemporary outpatient management of patients with worsening heart failure with reduced ejection fraction: Rationale and design of the CHART-HF study

Cited by 7 publications

References 37 publications

Developing Clinical Risk Prediction Models for Worsening Heart Failure Events and Death by Left Ventricular Ejection Fraction

Developing Clinical Risk Prediction Models for Worsening Heart Failure Events and Death by Left Ventricular Ejection Fraction

Regional management of worsening heart failure: rationale and design of the CHAIN‐HF registry

Why do clinicians not prescribe quadruple medical therapy for heart failure with reduced ejection fraction?

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