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- Title
Identification of patients with acute heart failure safe for emergency department discharge.
- Authors
Collins, Sean P.; Chioncel, Ovidiu; Fermann, Gregory J.; Levy, Phillip D.; Storrow, Alan B.; Pang, Peter S.
- Abstract
Objectives - The emergency department (ED) is the starting point of care for the vast majority of patients hospitalized with acute heart failure (AHF). However, the evidence base to guide dispositions decisions and identify patients for early, safe discharge is relatively weak. As a result, the majority of patients are admitted. However, because clinicians are faced with the daily challenge of risk-stratifying patients to help determine who potentially could be sent home, this remains an area of intense investigation. In this review, we outline an expert consensus on how to risk-stratify ED patients with AHF. Methodology - Expert consensus literature review. Results - The evidence to support firm conclusions regarding risk-stratification to identify a low risk-cohort safe for ED discharge is lacking. Several risk scores have been developed, though all have limitations, suggesting they should not be routinely used in clinical practice. However, several of these scores are currently undergoing external validation. Patients with elevated blood pressure, preserved renal function and a normal cardiac troponin during their ED work-up are lower risk. In combination with good response to ED therapy, close outpatient follow up, and good self-care skills, these patients represent candidates for early, safe ED discharge. Conclusions - Most ED patients with AHF are admitted, however, a sizable proportion may be safely discharged. Although further work is needed, identifi cation of lower risk patients is currently possible with existing risk markers, such as blood pressure, renal function, and troponin.
- Subjects
HEART failure; HOSPITAL admission &; discharge; CARDIOVASCULAR emergencies
- Publication
Romanian Journal of Cardiology, 2016, Vol 26, Issue 3, p249
- ISSN
1220-658X
- Publication type
Article