Optimizing treatment and outcomes in acute heart failure: beyond initial triage.
Heart failure contributes substantially to health care costs in the United States due to its prevalence and frequent necessity for repeat hospitalizations to manage episodes of acute decompensation. Heart failure overwhelmingly impacts Medicare costs, as the highest proportion of heart failure patients are older than 65 years of age. Efforts to reduce morbidity, mortality, and health care resource utilization have been achieved successfully through emergency department-based heart failure observation units. For select patients, the observation unit can provide care with effective oral agents, including angiotensin-converting enzyme inhibitors, beta-adrenergic receptor blockers, and diuretics, as well as administration of other vasoactive agents, followed by a discharge plan of effective heart failure education and rigorous follow-up management. As advanced pharmacologic and diagnostic therapies continue to emerge, the observation unit staff can play an integral role in the critical education and self-management tools that are needed by the patient to ultimately improve outcomes and quality of life.
Silver
Marc A
MA
Heart Failure Institute, Advocate Christ Medical Center, Oak Lawn, IL 60453, USA. marc.silver@advocatehealth.com
Peacock
W Franklin
WF
Diercks
Deborah B
DB
D000208:Acute Disease; D000465:Algorithms; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy*; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D019370:Observation; D010343:Patient Admission; D016896:Treatment Outcome; D014218:Triage; D014665:Vasodilator Agents / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D014665:Vasodilator Agents