title: The COACH risk engine: a multistate model for predicting survival and hospitalization in patients with heart failure.
abstract: OBJECTIVE
  Several models for predicting the prognosis of heart failure (HF) patients have been developed, but all of them focus on a single outcome variable, such as all-cause mortality. The purpose of this study was to develop a multistate model for simultaneously predicting survival and HF-related hospitalization in patients discharged alive from hospital after recovery from acute HF.
  
  
  RESULTS
  The model was derived in the COACH (Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure) cohort, a multicentre, randomized controlled trial in which 1023 patients were enrolled after hospitalization because of HF. External validation was attained with the FINN-AKVA (Finish Acute Heart Failure Study) cohort, a prospective, multicentre study with 620 patients hospitalized due to acute HF. The observed vs. predicted 18-month survival was 72.1% vs. 72.3% in the derivation cohort and 71.4% vs. 71.2% in the validation cohort. The corresponding values of the c statistic were 0.733 [95% confidence interval (CI) 0.705-0.761] and 0.702 (95% CI 0.663-0.744), respectively. The model's accuracy in predicting HF hospitalization was excellent, with predicted values that closely resembled the values observed in the derivation cohort.
  
  
  CONCLUSIONS
  The COACH risk engine accurately predicted survival and various measures of recurrent hospitalization in (acute) HF patients. It may therefore become a valuable tool in improving and personalizing patient care and optimizing the use of scarce healthcare resources.
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands. d.postmus@umcg.nl
authors.forename: Douwe
authors.initials: D
authors.lastname: Postmus
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Luttik
authors.forename: Johan
authors.initials: J
authors.lastname: Lassus
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.forename: James
authors.initials: J
authors.lastname: Lewsey
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors