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Updated: Sep 2, 2025
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Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
203
Alerting Clinicians to 1-Year Mortality Risk in Patients Hospitalized With Heart Failure: The REVEAL-HF Randomized
Tariq Ahmad1,2, Nihar R Desai1,2, Yu Yamamoto2
1Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
JAMA Cardiology
|August 10, 2022
Summary
Providing clinicians with 1-year mortality risk estimates for heart failure patients did not significantly reduce hospital readmissions or mortality. This randomized trial found no impact on clinical decision-making or patient outcomes.
Area of Science:
- Cardiology
- Clinical Trials
- Health Informatics
Background:
- Heart failure is a leading cause of morbidity and mortality globally.
- Risk scores can potentially optimize interventions for heart failure patients, but this requires clinical validation.
Purpose of the Study:
- To determine if prognostic risk information for heart failure improves clinical decisions regarding treatment initiation and intensity.
- To assess the impact on end-of-life care and subsequent rates of hospitalization or death.
Main Methods:
- A pragmatic, multicenter, randomized clinical trial using electronic health records.
- Patients hospitalized for heart failure with elevated NT-proBNP levels were randomized to an alert group or usual-care group.
- The alert group received clinician-facing 1-year mortality risk estimates derived from an EHR-based algorithm.
Main Results:
- The primary outcome (30-day readmissions and 1-year all-cause mortality) did not differ significantly between the alert and usual-care groups (38.9% vs 39.3%, P=.89).
- No significant differences were observed in heart failure medication prescriptions, ICD placement, or palliative care referrals.
- The predictive model for mortality achieved an area under the curve of 0.74 in the trial population.
Conclusions:
- Providing 1-year mortality risk estimates to clinicians during heart failure hospitalization did not improve patient outcomes.
- The intervention did not significantly alter clinical decision-making regarding treatment or end-of-life care.
- Further research is needed to identify effective strategies for integrating prognostic information into clinical practice.
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