Analysis of standards of quality for outcomes in acute heart failure patients directly discharged home from emergency departments and their relationship with the emergency department direct discharge rate

•The study checked the level of achievement of defined quality standards for outcomes.•The Spanish emergency departments (ED) are quite far from fulfilling these proposed standards.•Experts recommended direct discharge for EDs able to observe acute heart failure patients should be over 40%.•Only 12% of Spanish EDs achieve the 40% of direct discharge.•High percentages of direct discharge from ED negatively impact revisit or hospitalization but not mortality. Experts recommended that direct discharge without hospitalization (DDWH) for emergency departments (EDs) able to observe acute heart failure (AHF) patients should be >40%, and these discharged patients should fulfil the following outcome standards: 30-day all-cause mortality