Emergency department physicians in all Kaiser Permanente Northern California hospitals can now use a risk tool to help them evaluate patients with heart failure who develop new or worsening symptoms.
The computerized risk calculator, which was developed by Kaiser Permanente researchers, helps doctors determine which patients could potentially be cared for safely outside the hospital and which ones need to be admitted.
The tool, called STRIDE-HF (Systematic Tool for Risk Identification and Decision-making in Emergency Heart Failure), became available in all Kaiser Permanente Northern California hospitals after a series of studies showed it was safe and effective. The most recent study to support its use was published in June in the Journal of the American College of Cardiology: Heart Failure.
“It took us 10 years to go from identifying the need to better determine which patients were low risk and which patients were high risk to putting this tool in place in our emergency departments to help guide physician decision-making,” said Dana Sax, MD, MPH, a research scientist with the Division of Research and an emergency medicine physician who led the tool’s development. “We had to develop and test the tool and build it into our electronic health record as well as collaborate with many specialists to bring the tool into the hospital setting.”
The calculator uses information about the patient’s current status at the emergency department and their health history to assess in real time their risk of experiencing a heart attack, another serious problem, or dying in the next 30 days. Once the risk score is calculated, physicians can choose to simply view the risk category or open a report that provides additional treatment information. Patients who are high risk are admitted to the hospital. Patients who are low or very low risk are further assessed to determine if they can be cared for outside the hospital.
The recent study included more than 13,000 Kaiser Permanente patients seen in an emergency department from January through December 2023. The study found that the risk tool accurately identified the patients who could be considered for treatment outside the hospital.
A common condition
People who are experiencing heart-failure symptoms, including shortness of breath, weakness, fatigue, or coughing and wheezing, will often go to the emergency department for care.
Heart failure occurs when the heart is unable to pump as much blood as the body needs. The condition, which worsen over time, can cause damage to the kidneys and other organs. It also can cause fluid buildup in the lungs.
The researchers found that the tool helped patients and physicians discuss and develop a care plan.
“Physicians told us they found it helpful to share the risk assessment with patients to explain their recommendations,” said Dr. Sax. “The report is also available to all providers in the hospital — which is an additional benefit.”
