Safe discharge of acute heart failure patients from the emergency department

Article title: European Society of Cardiology – Acute Cardiovascular Care Association position paper on safe discharge of acute heart failure patients from the emergency department

From European Heart Journal: Acute Cardiovascular Care

Heart failure is a global public health challenge, with as many as 15 million Europeans and 5.7 million US citizens living with this diagnosis. It is characterized by frequent hospitalizations, estimated to exceed one million annual admissions in each of Europe and the USA, and accounts for the majority of the yearly costs of heart failure-related care. Ultimately, successful strategies to safely avoid hospitalization could have a major impact, not only on the quality of life for heart failure patients, but also on societal costs.  Authors of this paper conclude the challenge is to provide the best patient care while balancing proper treatment and resource use. For those emergency departments (Eds) having observation units, these settings seem an appropriate place to evaluate treatment response, as well as to arrange and ensure proper short term follow-up. They propose a consensus algorithm based on previous papers and on the authors own experience in order to be applied at EDs and to give some advice to emergency physicians treating Accute Heart Failure patients.

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.

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Article details
Clinical Practice/Education:
Òscar Miró, Frank W Peacock, John J McMurray, Héctor Bueno, Michael Christ, Alan S Maisel, Louise Cullen, Martin R Cowie, Salvatore Di Somma, Francisco J Martín Sánchez, Elke Platz, Josep Masip, Uwe Zeymer, Christiaan Vrints, Susanna Price, Alexander Mebazaa, Christian Mueller, and for the Acute Heart Failure Study Group of the ESC Acute Cardiovascular Care Association
European Society of Cardiology – Acute Cardiovascular Care Association position paper on safe discharge of acute heart failure patients from the emergency department
European Heart Journal: Acute Cardiovascular Care 2048872616633853, first published on February 21, 2016 doi:10.1177/2048872616633853

 

 

 

 

     
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