title: Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care.
abstract: BACKGROUND
  Chronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors.To characterise patients with CHF who seek an emergency department (ED) because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital.
  
  
  METHODS
  Patients (n = 2,648) seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF.
  
  
  RESULTS
  Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate.
  
  
  CONCLUSIONS
  The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.
authors.affiliation: Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra, University of Gothenburg, Gothenburg, Sweden. mshafazand@hotmail.com
authors.forename: Masoud
authors.initials: M
authors.lastname: Shafazand
authors.forename: Harshidaben
authors.initials: H
authors.lastname: Patel
authors.forename: Inger
authors.initials: I
authors.lastname: Ekman
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Maria
authors.initials: M
authors.lastname: Schaufelberger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000740:Anemia / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D002908:Chronic Disease; D018450:Disease Progression; D004417:Dyspnea / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D011014:Pneumonia / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D011654:Pulmonary Edema / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D015996:Survival Rate; D013548:Sweden