title: Emergency department visits for heart failure and subsequent hospitalization or observation unit admission.
abstract: BACKGROUND
  Treatment of acute heart failure in the emergency department (ED) or observation unit is an alternative to hospitalization. Both ED management and observation unit management have been associated with reduced costs and may be used to avoid penalties related to rehospitalizations. The purpose of this study was to examine trends in ED visits for heart failure and disposition following such visits.
  
  
  METHODS
  We used the National Hospital Ambulatory Medical Care Survey, a representative sample of ED visits in the United States, to estimate rates and characteristics of ED visits for heart failure between 2002 and 2010. The primary outcome was the discharge disposition from the ED. Regression models were fit to estimate trends and predictors of hospitalization and admission to an observation unit.
  
  
  RESULTS
  The number of ED visits for heart failure remained stable over the period, from 914,739 in 2002 to 848,634 in 2010 (annual change -0.7%, 95% CI -3.7% to +2.5%). Of these visits, 74.2% led to hospitalization, wheras 3.1% led to observation unit admission. The likelihood of hospitalization did not change during the period (adjusted prevalence ratio 1.00, 95% CI 0.99-1.01 for each additional year), whereas admission to the observation unit increased annually (adjusted prevalence ratio 1.12, 95% CI 1.01-1.25). We observed significant regional differences in likelihood of hospitalization and observation admission.
  
  
  CONCLUSIONS
  The number of ED visits for heart failure and the high proportion of ED visits with subsequent inpatient hospitalization have not changed in the last decade. Opportunities may exist to reduce hospitalizations by increasing short-term management of heart failure in the ED or observation unit.
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, NY; Department of Medicine, NYU School of Medicine, New York, NY.
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, NY; Department of Medicine, NYU School of Medicine, New York, NY.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ladapo
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, NY; Department of Emergency Medicine, NYU School of Medicine, New York, NY.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Doran
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, NY.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Goldfeld
authors.affiliation: Department of Medicine, NYU School of Medicine, New York, NY.
authors.forename: Stuart
authors.initials: S
authors.lastname: Katz
mesh_terms: D000208:Acute Disease; D000368:Aged; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D017050:Episode of Care; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D010346:Patient Care Management / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology