Accelerating Access and Improving Imaging in Heart Failure Care (A2I2HF) Pilot Study
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
Heart failure remains underdiagnosed in frontline care settings, in part due to limited access to timely echocardiography. Recent advances in artificial intelligence (AI)-assisted echocardiography may facilitate scalable bedside screening through automated image acquisition support and interpretation.
This is a prospective, multicenter, cluster randomised trial which will assess the feasibility and acceptability of routine implementation of AI-assisted point of care echocardiography on HF detection and downstream processes of care for patients with suspected HF being discharged from the Emergency Department.
This study will be carried out at 2 participating Emergency Departments (EDs) in Alberta, Canada. Each ED site will alternate monthly between Intervention (AI-assisted echocardiography) and Control (Usual Care) periods.
During intervention periods, patients with suspected HF will undergo AI-assisted echocardiography using a handheld point of care EchoNous Kosmos device by the treating ED physician. The US2.ai algorithm will generate an AI-automated echo report. During control periods, patients will be managed according to usual care.
Type d'étude
Inscription (Estimé)
Phase
- N'est pas applicable
Contacts et emplacements
Coordonnées de l'étude
- Nom: Clinical Trials Project Lead
- Numéro de téléphone: 1-800-707-9098
- E-mail: aa2i2@ualberta.ca
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
- Adulte
- Adulte plus âgé
Accepte les volontaires sains
La description
Inclusion Criteria:
- Adult patients age ≥18 years presenting to the ED;
- with signs or symptoms of HF as per the treating physician and
elevated natriuretic peptides (NT-proBNP>125pg/mL or BNP>50pg/mL); drawn as part of standard of care of evaluation in the ED, OR age≥ 40 years and ≥1 HF risk factor:
- Established diagnosis of type 2 diabetes
- Coronary artery disease (prior documented type 1 myocardial infarction or coronary artery bypass grafting or percutaneous coronary intervention or documented stenosis of an epicardial coronary artery (>50% left main or >70% left anterior descending, circumflex or right coronary artery)
- Previous ischemic or embolic stroke
- Peripheral artery disease (previous surgical or percutaneous revascularization or a documented stenosis greater than 50% of a major peripheral arterial vessel).
- Regular loop diuretic use
Exclusion Criteria:
- prior documented diagnosis of HF;
- any patient receiving renal replacement therapy;
- any patient receiving comfort or palliative care;
- pregnant or nursing patients;
- patients planned for admission
- Investigator/treating physician discretion: any patient not suitable for participation for other reasons
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Diagnostique
- Répartition: Randomisé
- Modèle interventionnel: Affectation séquentielle
- Masquage: Seul
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
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Expérimental: Intervention
During each month-long Intervention period, an AI-assisted POCUS tool will be available for ED physicians use, at their discretion, to assess left ventricular ejection fraction (LVEF) and diastolic function in patients presenting to the ED with suspected HF.
The AI-automated echocardiogram report may be used in the referral pathway to the HF clinic if deemed clinically appropriate.
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ED physicians at both sites will be provided with 1 session of in person training in the use of the AI-assisted POCUS device within 4 weeks of randomization including,
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Aucune intervention: Control Period (Usual Care)
During each month-long Control period, the ED physicians will manage patients as close to "true" usual care as possible.
There is no "placebo" arm.
No actions will be undertaken to impede or prohibit care in the usual care arm.
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Feasibility of AI Assisted Point of Care Echocardiography Implementation
Délai: During the enrollment period.
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Proportion of eligible patients successfully undergoing AI assisted echo assessment at the point of care.
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During the enrollment period.
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Mesures de résultats secondaires
Mesure des résultats |
Délai |
|---|---|
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Diagnosis of heart failure (HF) within 90 days
Délai: At 90 days.
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At 90 days.
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Downstream health care resource utilization at 90 days and 1 year (e.g. rates of requests for echocardiography, cardiology referral, primary care appointments, HF hospitalization).
Délai: At 90 days and 1 year.
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At 90 days and 1 year.
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Proportion of patients with HF receiving GDMT within 90 days
Délai: At 90 days.
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At 90 days.
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Difference in ratio of the incidence of diagnoses of HF via hospital admission-based versus community-based pathways
Délai: At 90 days.
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At 90 days.
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Uptake and utilization: differential rates of uptake and utilization of AI Assisted echocardiography in the emergency department
Délai: During the enrollment period.
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During the enrollment period.
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Determinants of uptake and utilization of AI assisted echocardiography in the emergency department (clinician questionnaire)
Délai: During the enrollment period.
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During the enrollment period.
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Collaborateurs et enquêteurs
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Justin Ezekowitz, MD, University of Alberta
- Chercheur principal: Safia Chatur, MD, Massachusetts General Hospital/Harvard Medical School and University of Alberta
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Estimé)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- A2I2HF
Informations sur les médicaments et les dispositifs, documents d'étude
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