Predicting the risk of reattendance for acute heart failure patients discharged from Spanish Emergency Department observation units
- 1 August 2010
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in European Journal of Emergency Medicine
- Vol. 17 (4), 197-202
- https://doi.org/10.1097/mej.0b013e32832f7666
Abstract
Patients with acute heart failure (AHF) are frequently evaluated in the Emergency Departments (ED) and discharged from their observation units (OU) without hospital admission. We examined direct discharge rates from the ED OU, risk factors for returning to the ED, and returning and mortality rates. This prospective, longitudinal, noninterventional, population-based cohort study included all the patients with AHF consecutively attended in seven Spanish EDs who were directly discharged without hospital admission. Reattendance (dependent variable) was accepted if occurred during the next 30 days after discharge. Twenty-nine independent variables were recorded, covering epidemiological, clinical, and functional data. Two hundred and fifty-nine of 740 patients (35%) diagnosed with AHF were entirely managed in the ED OU and discharged home (mean stay: 18.8 h); 26.7% of them were reattended. Only three variables were independently associated with the chance of reattendance: functional impairment predicted adverse outcomes [odds ratio (OR): 4.0, 95% confidence interval (95% CI): 1.7-9.1], while past history of hypertension and a systolic blood pressure greater than 160 mmHg at ED arrival decreased the risk of ED return (OR: 0.4, 95% CI: 0.2-0.9; and OR: 0.3; 95% CI: 0.1-0.9; respectively). An overall mortality of 4.7% was recorded during the next 30 days. One-third of the patients consulting at the ED for an episode of AHF can be directly discharged from the OU of ED, with relatively low rates of reattendance (26.7%) and mortality (4.7%). Emergency physicians should be especially cautious discharging patients with functional dependence because they are at increased risk of returning.Keywords
This publication has 20 references indexed in Scilit:
- Predictors of mortality after discharge in patients hospitalized with heart failure: An analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)American Heart Journal, 2008
- Acute heart failure in the emergency department: Short and long‐term outcomes of elderly patients with heart failureEuropean Journal of Heart Failure, 2008
- Acute Heart Failure SyndromesCirculation, 2005
- United States Emergency Department Visits for Acute Decompensated Heart Failure, 1992 to 2001The American Journal of Cardiology, 2005
- Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of CardiologyEuropean Heart Journal, 2005
- Impact of specialist follow-up in outpatients with congestive heart failureCMAJ : Canadian Medical Association Journal, 2005
- Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT)Journal of the American College of Cardiology, 2004
- Epidemiología de la insuficiencia cardíacaRevista Espanola de Cardiologia, 2004
- Outcomes after emergency department discharge with a primary diagnosis of heart failureAmerican Heart Journal, 2001
- Survival after the onset of congestive heart failure in Framingham Heart Study subjects.Circulation, 1993