Low-risk acute heart failure patients: external validation of the Society of Chest Pain Center's recommendations.
BACKGROUND
Risk-stratification in acute heart failure syndromes (AHFS) is problematic. A recent set of recommendations describes emergency department (ED) patients with AHFS who do not fulfill high-risk criteria and may be good candidates for observation unit (OU) management. The goal of this analysis was to report on the outcomes experienced by ED patients with AHFS who do not have any of these high-risk criteria.


METHODS
We performed a secondary analysis of the HEart failure and Audicor technology for Rapid Diagnosis and Initial Treatment (HEARD-IT) multinational study. HEARD-IT was a multicenter study designed to test the impact of acoustic cardiography on ED decision making in patients with possible AHFS. For the purposes of the current analysis we identified a subset of HEARD-IT patients who did not fulfill any high-risk criteria based on published data. The proportion of these patients who experienced an adverse outcome was determined.


RESULTS
The 201 subjects who fulfilled the inclusion criteria had a mean age of 64 years (SD: 13), 61% were male, 34% were Caucasian, and 55% were black. There were a total of 25 (12.4%) cardiac events, including 1 death due to AHFS. The majority of the cardiac events were 30-day readmissions related to AHFS (16/25, 64.0%).


CONCLUSIONS
AHFS patients at low-risk for subsequent morbidity and mortality based on recent consensus guidelines may be good candidates for early discharge after a brief period of observation in the OU or ED. Additional prospective research is needed to determine the impact of implementation of these criteria in ED patients with AHFS.
Collins
Sean P
SP
Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45267-0769, USA. sean.collins@uc.edu
Lindsell
Christopher J
CJ
Naftilan
Allen J
AJ
Peacock
W Frank
WF
Diercks
Deborah
D
Hiestand
Brian
B
Maisel
Alan
A
Storrow
Alan B
AB
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D019091:Critical Pathways; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome