The challenge of heart failure discharge from the emergency department.
Acute decompensated heart failure is a common reason for presentation to the emergency department and is associated with high rates of admission to hospital. Distinguishing between higher-risk patients needing hospitalization and lower-risk patients suitable for discharge home is important to optimize both cost-effectiveness and clinical outcomes. However, this can be challenging and few validated risk stratification tools currently exist to help clinicians. Some prognostic variables predict risks broadly in those who are admitted or discharged from the emergency department. Risk stratification methods such as the Emergency Heart Failure Mortality Risk Grade and Acute Heart Failure Index clinical decision support tools, which utilize many of these predictors, have been found to be accurate in identifying low-risk patients. The use of observation units may also be a cost-effective adjunctive strategy that can assist in determining disposition from the emergency department.
Institute for Clinical Evaluative Sciences, Division of Cardiology, University Health Network, Room G-106, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
Edwin C
EC
Ho
Michael J
MJ
Schull
Douglas S
DS
Lee
D004636:Emergency Service, Hospital; D006333:Heart Failure / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D006757:Hospital Units / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D010351:Patient Discharge / Q000191:economics; D010359:Patient Readmission / Q000191:economics; D011379:Prognosis; D018570:Risk Assessment / Q000191:economics / Q000379:methods*; D014218:Triage / Q000191:economics / Q000379:methods*