title: Effective observation unit treatment of decompensated heart failure.
abstract: There is little information on the effectiveness of emergency department (ED) observation unit (OU) heart failure (HF) therapy. The authors' objective was to evaluate outcomes after implementation of an ED-OU treatment protocol for HF exacerbation. Unblinded assessment of the effectiveness of an HF protocol was performed, controlled by outcome for 9 months prior to implementation. This included diagnostic and therapeutic algorithms, cardiology consultation, close monitoring, patient education, and discharge planning. Adverse outcomes were defined as the 90-day rates of ED HF revisits, hospital HF readmissions, or death, as determined by chart review, computer database search, and phone follow-up. One hundred fifty-four patients were enrolled; 50 entered before, and 104 after protocol implementation. Only six (12%) in the preprotocol and one (1%) of the postprotocol group were lost to follow-up. After an OU visit, postprotocol 90-day ED HF revisit rates declined 56% (0.90-0.51; p<0.0000) and the 90-day HF rehospitalization rate decreased 64% (0.77-0.50; p=0.007). The 90-day rates of death and OU HF readmission decreased from 4% to 1% (p=0.096) and 18% to 11% (p=0.099), respectively. An intensive outpatient ED OU HF management protocol safely decreases 90-day rates of emergency department visits and inpatient hospitalizations.
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH 44195, USA. peacocw@ccf.org
authors.forename: William Franklin
authors.initials: WF
authors.lastname: Peacock
authors.forename: Erica E
authors.initials: EE
authors.lastname: Remer
authors.forename: Josef
authors.initials: J
authors.lastname: Aponte
authors.forename: Donald A
authors.initials: DA
authors.lastname: Moffa
authors.forename: Charles E
authors.initials: CE
authors.lastname: Emerman
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome