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Disposition of emergency department patients diagnosed with acute heart failure: an international emergency medicine perspective

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Many patients with acute heart failure are initially managed in emergency departments (EDs) worldwide. Although some require hospitalization for further management, it is likely that a sizeable proportion could be safely discharged either directly from the ED or after a more extended period of management in an observation-type unit. Identification of low-risk patients who are safe for such an approach to management continues to be a global unmet need. This is driven in part by a lack of clarity on postdischarge outcomes for lower risk patients and a nonexistent consensus on what may be acceptable event rates. The current paper reviews previous studies carried out on patients directly discharged from the ED, suggests a general disposition algorithm and focuses on discharge metrics, which are based on both evidence and expert opinion. In addition, we propose that the following variables be considered for future determination of acceptable event rates: (a) baseline characteristics and risk status of the patient; (b) access to follow-up; (c) ED capability to provide an extended period of observation before discharge; (d) the temporal relationship between the event and ED discharge decision; and (e) the type of event experienced.
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Keywords: acute heart failure; emergency department; patient discharge; patient disposition; risk stratification

Document Type: Research Article

Affiliations: 1: Emergency Department, Hospital Clínic, Barcelona, Catalonia, ‘Emergencies: Processes and Pathologies’ Research Group, IDIBAPS, Barcelona 2: Department of Emergency Medicine and Cardiovascular Research Institute, Wayne State University, Detroit, Michigan 3: Department of Cardiology, Division of Emergency Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum und Charité Mitte, Berlin, Germany 4: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana 5: Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus 6: Catalonia, and ICD-SEMES Research Group, 6Instituto de investigación i+12 Research Institute and Cardiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain 7: Department of Emergency Medicine and National Academic Center for Telehealth, Philadelphia, Sidney Kimmel Medical College of Thomas Jefferson University 8: Department of Emergency Care, Division of Emergency Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland 9: Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas 10: Emergency Medicine Research Group, Department of Emergency Medicine, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK 11: Department of Medical-Surgery Sciences and Translational Medicine Emergency Department Sant’Andrea Hospital, University of Rome La Sapienza, Rome, Italy 12: Einstein Medical Center Montgomery; Vice President & Chief Nursing Officer, East Norriton, Pennsylvania 13: Department of Emergency Medicine, Vanderbilt University, and The Veterans Health Administration, Nashville, Tennessee, USA

Publication date: February 1, 2017

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