Document Detail

Is hospital admission for heart failure really necessary?: the role of the emergency department and observation unit in preventing hospitalization and rehospitalization.
MedLine Citation:
PMID:  23273288     Owner:  NLM     Status:  MEDLINE    
Approximately 800,000 times a year, an emergency physician admits a patient with symptomatic heart failure (HF). Yet only a minority of emergency department patients with HF are severely ill as a result of pulmonary edema, myocardial ischemia, or cardiogenic shock. The majority of patients are not in need of an acute intervention beyond decongestion, and few patients during hospitalization undergo invasive diagnostic testing or therapeutic procedures that require intense monitoring. Although hospitalization is clearly an inflection point, marking a threshold that independently predicts a worse outcome, the exact impact of hospitalization on post-discharge events has not been well elucidated. Thus, large subsets of patients with HF are hospitalized without a clear need for time-sensitive therapies or procedures. The authors estimate that up to 50% of emergency department patients with HF could be safely discharged after a brief period of observation, thus avoiding unnecessary admissions and minimizing readmissions. Observation unit management may be beneficial for low-risk and intermediate-risk patients with HF as continued treatment, and more precise risk stratification may ensue, avoiding inpatient admission. Whether observation unit management is comparable with or superior to the current approach must be determined in a randomized clinical trial. Critical end points include time to symptom resolution and discharge, post-discharge event rates, and a cost-effective analysis of each management strategy. It is the authors' strong assertion that now is the time for such a trial and that the results will be critically important if we are to effectively influence hospitalizations for HF in the near future.
Sean P Collins; Peter S Pang; Gregg C Fonarow; Clyde W Yancy; Robert O Bonow; Mihai Gheorghiade
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  61     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-31     Completed Date:  2013-03-01     Revised Date:  2014-01-23    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  121-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Emergency Service, Hospital*
Heart Failure / therapy*
Patient Discharge
Risk Assessment
Triage / methods*
Grant Support
Comment In:
J Am Coll Cardiol. 2013 Jun 18;61(24):2491   [PMID:  23542107 ]
J Am Coll Cardiol. 2013 Jan 15;61(2):127-30   [PMID:  23273289 ]
J Am Coll Cardiol. 2013 Jun 18;61(24):2490-1   [PMID:  23542100 ]

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