title: European Society of Cardiology - Acute Cardiovascular Care Association position paper on safe discharge of acute heart failure patients from the emergency department.
abstract: Heart failure is a global public health challenge frequently presenting to the emergency department. After initial stabilization and management, one of the most important decisions is to determine which patients can be safely discharged and which require hospitalization. This is a complex decision that depends on numerous subjective factors, including both the severity of the patient's underlying condition and an estimate of the acuity of the presentation. An emergency department observation period may help select the correct option. Ideally, during an observation period, risk stratification should be carried out using parameters specifically designed for use in the emergency department. Unfortunately, there is little objective literature to guide this disposition decision. An objective and reliable definition of low-risk characteristics to identify early discharge candidates is needed. Benchmarking outcomes in patients discharged from the emergency department without hospitalization could aid this process. Biomarker determinations, although undoubtedly useful in establishing diagnosis and predicting longer-term prognosis, require prospective validation for emergency department disposition guidance. The challenge of identifying emergency department acute heart failure discharge candidates will only be overcome by future multidisciplinary research defining the current knowledge gaps and identifying potential solutions.
authors.affiliation: 1 Emergency Department, Hospital Clínic; Institut de Recerca Biomàdica August Pi i Sunyer (IDIBAPS), ICA-SEMES Research Group, Barcelona, Catalonia, Spain.
authors.forename: Òscar
authors.initials: Ò
authors.lastname: Miró
authors.affiliation: 2 Emergency Medicine, Baylor College of Medicine, Houston, USA.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Peacock
authors.affiliation: 3 British Heart Foundation Cardiovascular Research Centre, University of Glasgow, UK.
authors.forename: John J
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: 4 Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid; Instituto de Investigación i+12 y Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid; Universidad Complutense de Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.affiliation: 5 Department of Emergency and Critical Care Medicine, Klinikum Nürnberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Christ
authors.affiliation: 6 Coronary Care Unit and Heart Failure Program, Veteran Affairs (VA) San Diego, USA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
authors.affiliation: 7 Department of Emergency Medicine, Royal Brisbane and Women's Hospital, School of Public Health, Queensland University of Technology; School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
authors.affiliation: 8 Cardiology Department, Imperial College London (Royal Brompton Hospital), UK.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
authors.affiliation: 9 Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, Sant'Andrea Hospital, University La Sapienza, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.affiliation: 10 Emergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, ICA-SEMES Research Group, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Martín Sánchez
authors.affiliation: 11 Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
authors.forename: Elke
authors.initials: E
authors.lastname: Platz
authors.affiliation: 12 ICU Department, Consorci Sanitari Integral, University of Barcelona; Cardiology Department Hospital Sanitas CIMA, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Masip
authors.affiliation: 13 FEESC, Klinikum Ludwigshafen und Institut für Herzinfarktforschung Ludwigshafen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: 14 Faculty of Medicine and Health Sciences at University of Antwerp, Belgium.
authors.forename: Christiaan
authors.initials: C
authors.lastname: Vrints
authors.affiliation: 15 Royal Brompton and Harefield National Health Service Foundation Trust, London, UK.
authors.forename: Susanna
authors.initials: S
authors.lastname: Price
authors.affiliation: 16 Hospital Lariboisière, Université Paris Diderot, France.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: 17 Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D002309:Cardiology / Q000458:organization & administration*; D000066491:Clinical Decision-Making / Q000941:ethics*; D004452:Echocardiography / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D010351:Patient Discharge / Q000592:standards*; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers
keywords: Acute heart failure; discharge; emergency department; prognosis; risk stratification