Trial of an Intervention to Improve Acute Heart Failure Outcomes

The COACH trial a stepped-wedge, cluster-randomized study across 10 hospitals in Ontario, tested whether a hospital-based strategy using a validated point-of-care algorithm (EHMRG30-ST) plus rapid follow-up in a transitional outpatient clinic could improve outcomes in patients with acute heart failure. Low-risk patients were discharged early and received standardized outpatient care, while high-risk patients were admitted. Among 5452 enrolled patients (2480 intervention phase, 2972 control), the composite of death or hospitalization for cardiovascular causes within 30 days occurred in 12.1% of intervention-phase patients vs. 14.5% of control-phase patients (HR 0.88; P=0.04). Over 20 months, cumulative event incidence was 54.4% vs. 56.2%, respectively (HR 0.95). Early discharge was safe, with <6 serious events in low/intermediate-risk patients prior to first outpatient visit. The strategy improved both early and extended outcomes in heart failure patients seeking emergency care, supporting risk-guided early discharge with structured post-discharge care.

The COACH trial a stepped-wedge, cluster-randomized study across 10 hospitals in Ontario, tested whether a hospital-based strategy using a validated point-of-care algorithm (EHMRG30-ST) plus rapid follow-up in a transitional outpatient clinic could improve outcomes in patients with acute heart failure. Low-risk patients were discharged early and received standardized outpatient care, while high-risk patients were admitted. Among 5452 enrolled patients (2480 intervention phase, 2972 control), the composite of death or hospitalization for cardiovascular causes within 30 days occurred in 12.1% of intervention-phase patients vs. 14.5% of control-phase patients (HR 0.88; P=0.04). Over 20 months, cumulative event incidence was 54.4% vs. 56.2%, respectively (HR 0.95). Early discharge was safe, with <6 serious events in low/intermediate-risk patients prior to first outpatient visit. The strategy improved both early and extended outcomes in heart failure patients seeking emergency care, supporting risk-guided early discharge with structured post-discharge care.