Health System Integration and Sustainability Improving heart failure care

Douglas Lee, Institute for Clinical Evaluative Sciences
Douglas Lee,
Institute for Clinical Evaluative Sciences

COACH Trial – Comparison of Outcomes and Access to Care for Heart Failure


  • Heart failure is a condition where the heart pump does not function normally, causing the lungs to become congested. The primary symptom of heart failure is shortness of breath, and this often leads to patients visiting the emergency department for care.
  • Many low-risk patients who could potentially be managed at home are admitted to hospital and some patients who are thought safe to discharge are actually high risk and will have adverse outcomes if they are discharged home from the emergency department.
  • The decision to admit or discharge patients with heart failure in the emergency department is complex because there are many factors to consider that make it difficult to know what the true prognosis of the patient is. In some cases, physicians admit low-risk patients to hospital because they are concerned that there will be a delay in the time to be seen by a heart specialist.


This research project will study 2 new strategies for heart failure care:

  1. This will use computer algorithms to help doctors make decisions in 10 Ontario emergency departments. Using smartphones, tablets, or desktop computers, this decision-supporting system will provide guidance to doctors to identify patients who will do well after early discharge. It will also help identify higher-risk patients who need care in the hospital.
  2. For those who are discharged home from the emergency department or after a short hospital stay, we will dramatically change how care is provided by having the heart specialist team rapidly see patients within ~2 days after discharge (RAPID HF clinic). For patients who are able, adjustments to heart medications and cardiac testing will be done as outpatients. Patients who need hospital care will continue to be hospitalized. High-quality care will become more patient-centred and accessible.

Patient engagement

  • The investigative team used an integrated knowledge transfer approach to engage patients in this project. Patients from three key areas were selected as representatives:
    1. a project Patient Advisory Committee
    2. consultation with patient organizations and advocacy groups (eg: Patients Canada, PANORAMA, and Health & Stroke Foundation)
    3. patients in the trial.
  • In the planning stage, patients from each of the groups were consulted in the study design. During the trial, patient representatives help prioritize secondary study outcomes and select a patient-centred outcome for reporting. At the end of the study, 3-5 patient representatives, who received training and support, will participate in the analysis and interpretation of the results. Input from the three patient groups will facilitate knowledge translation activities and actively share results with relevant communities using meetings and social media.


Photo credit: COACH Trial