title: Predicting the risk of reattendance for acute heart failure patients discharged from Spanish Emergency Department observation units.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Emergency Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Catalonia, Spain. omiro@clinic.ub.es
authors.forename: Oscar
authors.initials: O
authors.lastname: Miró
authors.forename: Pere
authors.initials: P
authors.lastname: Llorens
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Martín-Sánchez
authors.forename: Pablo
authors.initials: P
authors.lastname: Herrero
authors.forename: Javier
authors.initials: J
authors.lastname: Jacob
authors.forename: María José
authors.initials: MJ
authors.lastname: Pérez-Durá
authors.forename: Cesar
authors.initials: C
authors.lastname: González
authors.forename: Héctor
authors.initials: H
authors.lastname: Alonso
authors.forename: Victor
authors.initials: V
authors.lastname: Gil
authors.forename: Ana Bella
authors.initials: AB
authors.lastname: Alvarez
authors.forename: Rafel
authors.initials: R
authors.lastname: Perelló
authors.forename: Juan Jorge
authors.initials: JJ
authors.lastname: González-Armengol
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission; D011446:Prospective Studies; D012307:Risk Factors