title: Rates and predictive factors of return to the emergency department following an initial release by the emergency department for acute heart failure.
abstract: Following release by emergency department (ED) for acute heart failure (AHF), returns to ED represent important adverse health outcomes. The objective of this study was to document relapse events and factors associated with return to ED in the 14-day period following release by ED for patients with AHF.
  
  
  
  The primary outcome was the number of return to ED for patients who were release by ED after the initial visit, for any related medical problem within 14 days of this initial ED visit.
  
  
  
  Return visits to the EDs occurred in 166 (20%) patients. Of all patients who returned to ED within the 14-day period, 77 (47%) were secondarily admitted to the hospital. The following factors were associated with return visits to ED: past medical history of percutaneous coronary intervention or coronary artery bypass graft (aOR=1.51; 95% CIs [1.01-2.24]), current use of antiarrhythmics medications (1.96 [1.05-3.55]), heart rate above 80 /min (1.89 [1.28-2.80]), systolic blood pressure below 140 mm Hg (1.67[1.14-2.47]), oxygen saturation (SaO2) above 96% (1.58 [1.08-2.31]), troponin above the upper reference limit of normal (1.68 [1.15-2.45]), and chest X-ray with pleural effusion (1.52 [1.04-2.23]).
  
  
  
  Many heart failure patients (i.e. 1 in 5 patients) are released from the ED and then suffer return to ED. Patients with multiple medical comorbidities, and those with abnormal initial vital signs are at increased risk for return to ED and should be identified.
authors.affiliation: *Department of Anesthesia Resuscitation Pain Emergency Medicine,Nîmes University Hospital,Nîmes,France.
authors.forename: Pierre-Géraud
authors.initials: PG
authors.lastname: Claret
authors.affiliation: ‡Ottawa Hospital Research Institute,University of Ottawa,Ottawa,ON.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Calder
authors.affiliation: ‡Ottawa Hospital Research Institute,University of Ottawa,Ottawa,ON.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
authors.affiliation: ‡Ottawa Hospital Research Institute,University of Ottawa,Ottawa,ON.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Yan
authors.affiliation: ‡Ottawa Hospital Research Institute,University of Ottawa,Ottawa,ON.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Clement
authors.affiliation: ††Division of Emergency Medicine,University of Toronto,Toronto,ON.
authors.forename: Bjug
authors.initials: B
authors.lastname: Borgundvaag
authors.affiliation: ¶Department of Medicine,Ottawa Hospital Research Institute,Ottawa,ON.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Forster
authors.affiliation: ‡Ottawa Hospital Research Institute,University of Ottawa,Ottawa,ON.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
authors.affiliation: ‡‡Department of Emergency Medicine,University of Alberta,Edmonton,AB.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000208:Acute Disease; D000368:Aged; D002170:Canada / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D010351:Patient Discharge / Q000639:trends*; D010359:Patient Readmission / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013997:Time Factors
keywords: cohort studies; emergency service; heart failure; multivariate analysis; risk assessment