Assessing the risks of hospital readmissions for patients with heart failure in the East of England.

Insight 

One in five patients with heart failure in the East of England are readmitted to hospital within 30 days of being discharged from hospital. Many of these re-admissions are preventable. By analysing de-identified NHS patient data within the Eastern England Secure Data Environment (SDE), researchers are validating risk prediction tools that could transform how clinicians identify high-risk patients, helping to deliver more personalised care while reducing pressure on hospitals and the wider NHS.  

Intervention 

This retrospective cohort study uses de-identified, routinely collected NHS data from several NHS trusts in the region to improve care for people with heart failure.  Risk calculators have been developed to identify patients who are at high risk of death or readmission to hospital based on key measurements. However, these risk calculators have not previously been validated in the UK or implemented in UK clinical practice. The research team is validating these risk calculators and developing new dynamic models that incorporate real-time patient data and trends. 

The team will test a range of modelling techniques, including two-stage statistical models and machine learning to find the best-performing, most clinically-relevant approach. The goal is to integrate a validated risk calculator into NHS clinical systems, allowing clinicians to make better-informed, personalised decisions for heart failure patients.

“My research goal is to advance the prevention of multiple chronic diseases by harnessing population-wide health data. The health informatics team at Health innovation East, working with the research governance team at CUH, are helping to surface data in the Eastern England SDE that wouldn’t otherwise be available for research by working in partnership with NHS organisations from across the region. Collaborating with these dedicated and forward-thinking teams is incredibly rewarding, enhancing both the quality and impact of all our efforts.” Professor Angela Wood, Professor of Biostatistics and Health Data Science, University of Cambridge.  

Impact 

This study is delivering the first UK-validated risk calculator for heart failure readmission, improving clinical decision-making and personalising care for patients. It demonstrates how the Eastern England SDE enables secure research that helps to reduce avoidable hospital admissions and ultimately save lives. 

Mother and daugther playing piggyback riding

Project details +

Project ID

SDE_EE_PROJ_A0001

Project start date

2 October 2024

Project end date

30 September 2025

Team +

Lead applicant:

Dr Paul Cacciottolo
Consultant Cardiologist - Primary Investigator
Cambridge University Hospitals NHS Foundation Trust

Project team:

Name Job title Organisation
Prof Angela Wood Professor of Biostatistics and Health Data Science University of Cambridge
Wen Shi Research Associate University of Cambridge
Dr Jessica Barrett Principal Research Associate, MRC BSU University of Cambridge
Mr Teun Petersen Research Associate, MRC BSU University of Cambridge
About the project +

Is this project a multiple-SDE project?

No

Name of SDE parties

  • Not applicable
Patient and public involvement and engagement +

Are patients involved?

Patient groups have been involved and the project conducted a public consultation.
Data +

Data variables required

Data from: Cambridge University Hospitals NHS Foundation Trust Milton Keynes University Hospitals Norfolk and Norwich NHS Trust North West Anglia NHS Foundation Trust

Cohort size

24000

Criteria

Criteria include data from the last 10 years; data fields describing demographic attributes, medications during admission/hospital stay, medical history of conditions, physical measurements like weight and height, procedures, death dates and more.