Predicting the risk of reattendance for acute heart failure patients discharged from Spanish Emergency Department observation units.
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.
Miró
Oscar
O
Emergency Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Catalonia, Spain. omiro@clinic.ub.es
Llorens
Pere
P
Martín-Sánchez
Francisco Javier
FJ
Herrero
Pablo
P
Jacob
Javier
J
Pérez-Durá
María José
MJ
González
Cesar
C
Alonso
Héctor
H
Gil
Victor
V
Alvarez
Ana Bella
AB
Perelló
Rafel
R
González-Armengol
Juan Jorge
JJ
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