title: Multicentric investigation of survival after Spanish emergency department discharge for acute heart failure.
abstract: OBJECTIVE
  Ideally, discharges from the emergency department (ED) should be as safe as discharges after hospitalization. We have ascertained this hypothesis in patients with acute heart failure (AHF) directly discharged from EDs, analyzing their short-term outcome.
  
  
  METHODS
  A prospective, cohort, multicentric, noninterventional study of consecutive patients with AHF who visited in 20 Spanish EDs was conducted. Patients were grouped according to whether discharge had been from the ED (maximum 24-h ED stay) or after hospitalization. We collected baseline and current AHF episode data. Short-term outcome (30-day mortality and revisit rates) of both groups was compared by univariate crude analysis and stratified by predicted risk of 30-day mortality as well as by logistic regression adjustment for the differences found between ED and hospital groups.
  
  
  RESULTS
  A total of 1669 patients were analysed: 546 (32.7%) discharged from ED and 1123 (67.3%) after hospitalisation; 75 (4.5%) died and 420 (25.2%) revisited the ED. Crude 30-day mortality rates of ED and hospital discharges were 2.9 and 5.3%, respectively (odds ratio for ED discharge: 0.56; 95% confidence interval: 0.33-0.96), whereas 30-day revisit rates were 23.8 and 26.4% (odds ratio: 0.96; 95% confidence interval: 0.77-1.19). Stratified analysis according to predicted risk of mortality and multivariate analysis adjusted for the discrepancy in baseline and current AHF episode characteristics in ED and hospital discharges confirmed the lack of short-term outcome differences between the two groups.
  
  
  CONCLUSIONS
  Direct ED discharge of patients with AHF after treatment and a short observation period is as safe as discharge after a longer time of inpatient hospitalization in general wards.
authors.affiliation: Emergency Department, Área de Urgencias, Hospital Clínic, Villarroel 170, 08036 Barcelona, Catalonia, Spain. omiro@clinic.ub.es
authors.forename: Oscar
authors.initials: O
authors.lastname: Miró
authors.forename: Víctor
authors.initials: V
authors.lastname: Gil
authors.forename: Pablo
authors.initials: P
authors.lastname: Herrero
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Martín-Sánchez
authors.forename: Javier
authors.initials: J
authors.lastname: Jacob
authors.forename: Pere
authors.initials: P
authors.lastname: Llorens
mesh_terms: D000208:Acute Disease; D000368:Aged; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome