title: Comparison of management and outcomes of ED patients with acute decompensated heart failure between the Canadian and United States' settings.
abstract: Introduction The objective of this study was to compare the emergency department (ED) management and rate of admission of acute decompensated heart failure (ADHF) between two hospitals in Canada and the United States and to compare the outcomes of these patients.
  
  
  METHODS
  This was a health records review of adults presenting with ADHF to two EDs in Canada and the United States between January 1 and April 30, 2010. Outcome measures were admission to the hospital, myocardial infarction (MI), and death or relapse rates to the ED. Data were analysed using descriptive, univariate and multivariate analyses.
  
  
  RESULTS
  In total, 394 cases were reviewed and 73 were excluded. Comparing 156 Canadian to 165 U.S. patients, respectively, mean age was 76.0 and 75.8 years; male sex was 54.5% and 52.1%. Canadian and U.S. ED treatments were noninvasive ventilation 7.7% v. 12.8% (p=0.13); IV diuretics 77.6% v. 36.0% (p<0.001); IV nitrates 4.5% v. 6.7% (p=0.39). There were significant differences in rate of admission (50.6% v. 95.2%, p<0.001) and length of stay in ED (6.7 v. 3.0 hours, p<0.001). Proportion of Canadian and U.S. patients who died within 30 days of the ED visit was 5.1% v. 9.7% (p=0.12); relapsed to the ED within 30 days was 20.8% v. 17.5% (p=0.5); and had MI within 30 days was 2.0% v. 1.9% (p=1.0).
  
  
  CONCLUSIONS
  The U.S. and Canadian centres saw ADHF patients with similar characteristics. Although the U.S. site had almost double the admission rate, the outcomes were similar between the sites, which question the necessity of routine admission for patients with ADHF.
authors.affiliation: *Department of Emergency Medicine,Clinical Epidemiology Program,Ottawa Hospital Research Institute,University of Ottawa,Ottawa,ON.
authors.forename: Anita
authors.initials: A
authors.lastname: Lai
authors.affiliation: †Department of Emergency Medicine,Mayo Clinic,Rochester,MN.
authors.forename: Elliott
authors.initials: E
authors.lastname: Tenpenny
authors.affiliation: †Department of Emergency Medicine,Mayo Clinic,Rochester,MN.
authors.forename: David
authors.initials: D
authors.lastname: Nestler
authors.affiliation: †Department of Emergency Medicine,Mayo Clinic,Rochester,MN.
authors.forename: Erik
authors.initials: E
authors.lastname: Hess
authors.affiliation: *Department of Emergency Medicine,Clinical Epidemiology Program,Ottawa Hospital Research Institute,University of Ottawa,Ottawa,ON.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
mesh_terms: D000208:Acute Disease; D000368:Aged; D002170:Canada / Q000453:epidemiology; D019468:Disease Management; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D010343:Patient Admission / Q000639:trends; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: emergency department; health records review; heart failure