title: Risk stratification in acute heart failure: rationale and design of the STRATIFY and DECIDE studies.
abstract: BACKGROUND
  A critical challenge for physicians facing patients presenting with signs and symptoms of acute heart failure (AHF) is how and where to best manage them. Currently, most patients evaluated for AHF are admitted to the hospital, yet not all warrant inpatient care. Up to 50% of admissions could be potentially avoided and many admitted patients could be discharged after a short period of observation and treatment. Methods for identifying patients that can be sent home early are lacking. Improving the physician's ability to identify and safely manage low-risk patients is essential to avoiding unnecessary use of hospital beds.
  
  
  METHODS
  Two studies (STRATIFY and DECIDE) have been funded by the National Heart Lung and Blood Institute with the goal of developing prediction rules to facilitate early decision making in AHF. Using prospectively gathered evaluation and treatment data from the acute setting (STRATIFY) and early inpatient stay (DECIDE), rules will be generated to predict risk for death and serious complications. Subsequent studies will be designed to test the external validity, utility, generalizability and cost-effectiveness of these prediction rules in different acute care environments representing racially and socioeconomically diverse patient populations.
  
  
  RESULTS
  A major innovation is prediction of 5-day as well as 30-day outcomes, overcoming the limitation that 30-day outcomes are highly dependent on unpredictable, post-visit patient and provider behavior. A novel aspect of the proposed project is the use of a comprehensive cardiology review to correctly assign post-treatment outcomes to the acute presentation.
  
  
  CONCLUSIONS
  Finally, a rigorous analysis plan has been developed to construct the prediction rules that will maximally extract both the statistical and clinical properties of every data element. Upon completion of this study we will subsequently externally test the prediction rules in a heterogeneous patient cohort.
authors.affiliation: Vanderbilt University, Nashville, TN, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Jenkins
authors.forename: Frank E
authors.initials: FE
authors.lastname: Harrell
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fermann
authors.forename: Karen F
authors.initials: KF
authors.lastname: Miller
authors.forename: Sue N
authors.initials: SN
authors.lastname: Roll
authors.forename: Matthew I
authors.initials: MI
authors.lastname: Sperling
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Naftilan
authors.forename: John A
authors.initials: JA
authors.lastname: McPherson
authors.forename: Neal L
authors.initials: NL
authors.lastname: Weintraub
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Sawyer
authors.forename: Alan B
authors.initials: AB
authors.lastname: Storrow
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004632:Emergency Medical Services; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D010343:Patient Admission; D010351:Patient Discharge; D011446:Prospective Studies; D012107:Research Design; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult