Studies like these are a window into the future of medicine – electronic health records beget clinician decision-support tools that allow highly complex risk-stratification tools to guide clinical practice. Tools like NEXUS will wither on the vine as oversimplifications of complex clinical decisions – oversimplifications that were needed in a pre-EHR era where decision instruments needed to be memorized.
This study is a prospective observational validation of the “Acute Heart Failure Index” rule – derived in Pittsburgh, applied at Columbia. The AHFI branch points for risk stratification are…best described below, in this extraordinarily complex flow diagram:
Essentially, the research assistants in the ED applied an electronic version of this tool to all patients given by the Emergency Physician a diagnosis of decompensated heart failure – and then followed them for the primary outcome(s) of death or readmission within 30 days. In the end, in their small sample size, they find 10% of their low-risk population meets the combined endpoint, while 30.2% of their high-risk population meets their combined endpoint. Neither group had a very high mortality – most of the difference between groups comes from re-admissions within 30 days.
So, what makes this study important isn’t the AHFI, or that it is reasonable to suggest further research might validate this rule as an aid to clinical decision-making – it’s the progression forwards of using CDS in EHR to synthesize complex medical data into potentially meaningful clinical guidance.
“Validating the acute heart failure index for patients presenting to the emergency department with decompensated heart failure”
http://www.ncbi.nlm.nih.gov/pubmed/22158534