Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes
Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is asso...
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| Veröffentlicht in: | Internal and emergency medicine 2023-06, Vol.18 (4), p.1159-1168 |
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| creator | Sánchez-Marcos, Carolina Jacob, Javier Llorens, Pere López-Díez, María Pilar Millán, Javier Martín-Sánchez, Francisco Javier Tost, Josep Aguirre, Alfons Juan, María Ángeles Garrido, José Manuel Rodríguez, Rafael Calvo Pérez-Llantada, Enrique Díaz, Elena Sánchez-Nicolás, José Andrés Mir, María Rodríguez-Adrada, Esther Herrero, Pablo Gil, Víctor Roset, Alex Peacock, Frank Miró, Òscar |
| description | Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is associated with early adverse outcomes versus hospitalization in SSU. Endpoints, defined as 30-day all-cause mortality or post-discharge adverse events, were evaluated in patients diagnosed with AHF in 17 Spanish EDs with an SSU, and compared by ED discharge vs. SSU hospitalization. Endpoint risk was adjusted for baseline and AHF episode characteristics and in patients matched by propensity score (PS) for SSU hospitalization. Overall, 2358 patients were discharged home and 2003 were hospitalized in SSUs. Discharged patients were younger, more frequently men, with fewer comorbidities, had better baseline status, less infection, rapid atrial fibrillation and hypertensive emergency as the AHF trigger, and had a lower severity of AHF episode. While their 30-day mortality rate was lower than in patients hospitalized in SSU (4.4% vs. 8.1%,
p
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| doi_str_mv | 10.1007/s11739-023-03197-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10326134</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2779346236</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-74cc06de86295dc601cc10bf83ce8a299ed55b495a723d849c45cc084f6b1f63</originalsourceid><addsrcrecordid>eNp9UcmO1DAQjRCIGQZ-gAOyxIVLwFu8cEFoNCzSSFzmbrmdSsejJG5sh1F_Cz9LNd0My4FTWXpbuV7TPGf0NaNUvymMaWFbykVLBbO6tQ-ac5y0tUKph_g23LRUSn3WPCnlltKuU0w_bs6EMoxa1Z03369myFtYwp70sPO5zrBU0scM4TBKGD3CJKQZQehJTaSMKde2VL8n6xIr8f0cS4lpIUPKpMCEUmTufI3oVchdrCPxYa1ARsAEMvg4rRneEr_4aV9iIWk4uVbIM0lrxTwoT5tHg58KPDvNi-bmw9XN5af2-svHz5fvr9sgdVdbLUOgqgejuO36oCgLgdHNYEQA47m10HfdRtrOay56I22QHSqMHNSGDUpcNO-Otrt1M0MfcOnsJ7fLcfZ575KP7m9kiaPbpm-OUcEVExIdXp0ccvq6QqkOLxJgmvwCaS2Oa22FVFwcwl7-Q71Na8Y7IMsIgbVwyZDFj6yQUykZhvttGHWH7t2xe4fdu5_dO4uiF3_-417yq2wkiCOhILRsIf_O_o_tD6w5vuc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2833810241</pqid></control><display><type>article</type><title>Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes</title><source>SpringerLink Journals</source><creator>Sánchez-Marcos, Carolina ; Jacob, Javier ; Llorens, Pere ; López-Díez, María Pilar ; Millán, Javier ; Martín-Sánchez, Francisco Javier ; Tost, Josep ; Aguirre, Alfons ; Juan, María Ángeles ; Garrido, José Manuel ; Rodríguez, Rafael Calvo ; Pérez-Llantada, Enrique ; Díaz, Elena ; Sánchez-Nicolás, José Andrés ; Mir, María ; Rodríguez-Adrada, Esther ; Herrero, Pablo ; Gil, Víctor ; Roset, Alex ; Peacock, Frank ; Miró, Òscar</creator><creatorcontrib>Sánchez-Marcos, Carolina ; Jacob, Javier ; Llorens, Pere ; López-Díez, María Pilar ; Millán, Javier ; Martín-Sánchez, Francisco Javier ; Tost, Josep ; Aguirre, Alfons ; Juan, María Ángeles ; Garrido, José Manuel ; Rodríguez, Rafael Calvo ; Pérez-Llantada, Enrique ; Díaz, Elena ; Sánchez-Nicolás, José Andrés ; Mir, María ; Rodríguez-Adrada, Esther ; Herrero, Pablo ; Gil, Víctor ; Roset, Alex ; Peacock, Frank ; Miró, Òscar ; ICASEMES Research Group researchers ; The ICASEMES Research Group researchers</creatorcontrib><description>Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is associated with early adverse outcomes versus hospitalization in SSU. Endpoints, defined as 30-day all-cause mortality or post-discharge adverse events, were evaluated in patients diagnosed with AHF in 17 Spanish EDs with an SSU, and compared by ED discharge vs. SSU hospitalization. Endpoint risk was adjusted for baseline and AHF episode characteristics and in patients matched by propensity score (PS) for SSU hospitalization. Overall, 2358 patients were discharged home and 2003 were hospitalized in SSUs. Discharged patients were younger, more frequently men, with fewer comorbidities, had better baseline status, less infection, rapid atrial fibrillation and hypertensive emergency as the AHF trigger, and had a lower severity of AHF episode. While their 30-day mortality rate was lower than in patients hospitalized in SSU (4.4% vs. 8.1%,
p
< 0.001), 30-day post-discharge adverse events were similar (27.2% vs. 28.4%,
p
= 0.599). After adjustment, there were no differences in the 30-day risk of mortality of discharged patients (adjusted HR 0.846, 95% CI 0.637–1.107) or adverse events (1.035, 0.914–1.173). In 337 pairs of PS-matched patients, there were no differences in mortality or risk of adverse event between patients directly discharged or admitted to an SSU (0.753, 0.409–1.397; and 0.858, 0.645–1.142; respectively). Direct ED discharge of patients diagnosed with AHF provides similar outcomes compared to patients with similar characteristics and hospitalized in a SSU.</description><identifier>ISSN: 1828-0447</identifier><identifier>EISSN: 1970-9366</identifier><identifier>DOI: 10.1007/s11739-023-03197-9</identifier><identifier>PMID: 36810965</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adverse events ; Comorbidity ; Congestive heart failure ; EM - Original ; Emergency medical care ; Heart failure ; Hospitalization ; Internal Medicine ; Medicine ; Medicine & Public Health ; Mortality</subject><ispartof>Internal and emergency medicine, 2023-06, Vol.18 (4), p.1159-1168</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-74cc06de86295dc601cc10bf83ce8a299ed55b495a723d849c45cc084f6b1f63</citedby><cites>FETCH-LOGICAL-c475t-74cc06de86295dc601cc10bf83ce8a299ed55b495a723d849c45cc084f6b1f63</cites><orcidid>0000-0003-1101-1066</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11739-023-03197-9$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11739-023-03197-9$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36810965$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sánchez-Marcos, Carolina</creatorcontrib><creatorcontrib>Jacob, Javier</creatorcontrib><creatorcontrib>Llorens, Pere</creatorcontrib><creatorcontrib>López-Díez, María Pilar</creatorcontrib><creatorcontrib>Millán, Javier</creatorcontrib><creatorcontrib>Martín-Sánchez, Francisco Javier</creatorcontrib><creatorcontrib>Tost, Josep</creatorcontrib><creatorcontrib>Aguirre, Alfons</creatorcontrib><creatorcontrib>Juan, María Ángeles</creatorcontrib><creatorcontrib>Garrido, José Manuel</creatorcontrib><creatorcontrib>Rodríguez, Rafael Calvo</creatorcontrib><creatorcontrib>Pérez-Llantada, Enrique</creatorcontrib><creatorcontrib>Díaz, Elena</creatorcontrib><creatorcontrib>Sánchez-Nicolás, José Andrés</creatorcontrib><creatorcontrib>Mir, María</creatorcontrib><creatorcontrib>Rodríguez-Adrada, Esther</creatorcontrib><creatorcontrib>Herrero, Pablo</creatorcontrib><creatorcontrib>Gil, Víctor</creatorcontrib><creatorcontrib>Roset, Alex</creatorcontrib><creatorcontrib>Peacock, Frank</creatorcontrib><creatorcontrib>Miró, Òscar</creatorcontrib><creatorcontrib>ICASEMES Research Group researchers</creatorcontrib><creatorcontrib>The ICASEMES Research Group researchers</creatorcontrib><title>Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes</title><title>Internal and emergency medicine</title><addtitle>Intern Emerg Med</addtitle><addtitle>Intern Emerg Med</addtitle><description>Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is associated with early adverse outcomes versus hospitalization in SSU. Endpoints, defined as 30-day all-cause mortality or post-discharge adverse events, were evaluated in patients diagnosed with AHF in 17 Spanish EDs with an SSU, and compared by ED discharge vs. SSU hospitalization. Endpoint risk was adjusted for baseline and AHF episode characteristics and in patients matched by propensity score (PS) for SSU hospitalization. Overall, 2358 patients were discharged home and 2003 were hospitalized in SSUs. Discharged patients were younger, more frequently men, with fewer comorbidities, had better baseline status, less infection, rapid atrial fibrillation and hypertensive emergency as the AHF trigger, and had a lower severity of AHF episode. While their 30-day mortality rate was lower than in patients hospitalized in SSU (4.4% vs. 8.1%,
p
< 0.001), 30-day post-discharge adverse events were similar (27.2% vs. 28.4%,
p
= 0.599). After adjustment, there were no differences in the 30-day risk of mortality of discharged patients (adjusted HR 0.846, 95% CI 0.637–1.107) or adverse events (1.035, 0.914–1.173). In 337 pairs of PS-matched patients, there were no differences in mortality or risk of adverse event between patients directly discharged or admitted to an SSU (0.753, 0.409–1.397; and 0.858, 0.645–1.142; respectively). Direct ED discharge of patients diagnosed with AHF provides similar outcomes compared to patients with similar characteristics and hospitalized in a SSU.</description><subject>Adverse events</subject><subject>Comorbidity</subject><subject>Congestive heart failure</subject><subject>EM - Original</subject><subject>Emergency medical care</subject><subject>Heart failure</subject><subject>Hospitalization</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><issn>1828-0447</issn><issn>1970-9366</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>BENPR</sourceid><recordid>eNp9UcmO1DAQjRCIGQZ-gAOyxIVLwFu8cEFoNCzSSFzmbrmdSsejJG5sh1F_Cz9LNd0My4FTWXpbuV7TPGf0NaNUvymMaWFbykVLBbO6tQ-ac5y0tUKph_g23LRUSn3WPCnlltKuU0w_bs6EMoxa1Z03369myFtYwp70sPO5zrBU0scM4TBKGD3CJKQZQehJTaSMKde2VL8n6xIr8f0cS4lpIUPKpMCEUmTufI3oVchdrCPxYa1ARsAEMvg4rRneEr_4aV9iIWk4uVbIM0lrxTwoT5tHg58KPDvNi-bmw9XN5af2-svHz5fvr9sgdVdbLUOgqgejuO36oCgLgdHNYEQA47m10HfdRtrOay56I22QHSqMHNSGDUpcNO-Otrt1M0MfcOnsJ7fLcfZ575KP7m9kiaPbpm-OUcEVExIdXp0ccvq6QqkOLxJgmvwCaS2Oa22FVFwcwl7-Q71Na8Y7IMsIgbVwyZDFj6yQUykZhvttGHWH7t2xe4fdu5_dO4uiF3_-417yq2wkiCOhILRsIf_O_o_tD6w5vuc</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Sánchez-Marcos, Carolina</creator><creator>Jacob, Javier</creator><creator>Llorens, Pere</creator><creator>López-Díez, María Pilar</creator><creator>Millán, Javier</creator><creator>Martín-Sánchez, Francisco Javier</creator><creator>Tost, Josep</creator><creator>Aguirre, Alfons</creator><creator>Juan, María Ángeles</creator><creator>Garrido, José Manuel</creator><creator>Rodríguez, Rafael Calvo</creator><creator>Pérez-Llantada, Enrique</creator><creator>Díaz, Elena</creator><creator>Sánchez-Nicolás, José Andrés</creator><creator>Mir, María</creator><creator>Rodríguez-Adrada, Esther</creator><creator>Herrero, Pablo</creator><creator>Gil, Víctor</creator><creator>Roset, Alex</creator><creator>Peacock, Frank</creator><creator>Miró, Òscar</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1101-1066</orcidid></search><sort><creationdate>20230601</creationdate><title>Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes</title><author>Sánchez-Marcos, Carolina ; Jacob, Javier ; Llorens, Pere ; López-Díez, María Pilar ; Millán, Javier ; Martín-Sánchez, Francisco Javier ; Tost, Josep ; Aguirre, Alfons ; Juan, María Ángeles ; Garrido, José Manuel ; Rodríguez, Rafael Calvo ; Pérez-Llantada, Enrique ; Díaz, Elena ; Sánchez-Nicolás, José Andrés ; Mir, María ; Rodríguez-Adrada, Esther ; Herrero, Pablo ; Gil, Víctor ; Roset, Alex ; Peacock, Frank ; Miró, Òscar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-74cc06de86295dc601cc10bf83ce8a299ed55b495a723d849c45cc084f6b1f63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adverse events</topic><topic>Comorbidity</topic><topic>Congestive heart failure</topic><topic>EM - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Internal and emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sánchez-Marcos, Carolina</au><au>Jacob, Javier</au><au>Llorens, Pere</au><au>López-Díez, María Pilar</au><au>Millán, Javier</au><au>Martín-Sánchez, Francisco Javier</au><au>Tost, Josep</au><au>Aguirre, Alfons</au><au>Juan, María Ángeles</au><au>Garrido, José Manuel</au><au>Rodríguez, Rafael Calvo</au><au>Pérez-Llantada, Enrique</au><au>Díaz, Elena</au><au>Sánchez-Nicolás, José Andrés</au><au>Mir, María</au><au>Rodríguez-Adrada, Esther</au><au>Herrero, Pablo</au><au>Gil, Víctor</au><au>Roset, Alex</au><au>Peacock, Frank</au><au>Miró, Òscar</au><aucorp>ICASEMES Research Group researchers</aucorp><aucorp>The ICASEMES Research Group researchers</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes</atitle><jtitle>Internal and emergency medicine</jtitle><stitle>Intern Emerg Med</stitle><addtitle>Intern Emerg Med</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>18</volume><issue>4</issue><spage>1159</spage><epage>1168</epage><pages>1159-1168</pages><issn>1828-0447</issn><eissn>1970-9366</eissn><abstract>Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is associated with early adverse outcomes versus hospitalization in SSU. Endpoints, defined as 30-day all-cause mortality or post-discharge adverse events, were evaluated in patients diagnosed with AHF in 17 Spanish EDs with an SSU, and compared by ED discharge vs. SSU hospitalization. Endpoint risk was adjusted for baseline and AHF episode characteristics and in patients matched by propensity score (PS) for SSU hospitalization. Overall, 2358 patients were discharged home and 2003 were hospitalized in SSUs. Discharged patients were younger, more frequently men, with fewer comorbidities, had better baseline status, less infection, rapid atrial fibrillation and hypertensive emergency as the AHF trigger, and had a lower severity of AHF episode. While their 30-day mortality rate was lower than in patients hospitalized in SSU (4.4% vs. 8.1%,
p
< 0.001), 30-day post-discharge adverse events were similar (27.2% vs. 28.4%,
p
= 0.599). After adjustment, there were no differences in the 30-day risk of mortality of discharged patients (adjusted HR 0.846, 95% CI 0.637–1.107) or adverse events (1.035, 0.914–1.173). In 337 pairs of PS-matched patients, there were no differences in mortality or risk of adverse event between patients directly discharged or admitted to an SSU (0.753, 0.409–1.397; and 0.858, 0.645–1.142; respectively). Direct ED discharge of patients diagnosed with AHF provides similar outcomes compared to patients with similar characteristics and hospitalized in a SSU.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>36810965</pmid><doi>10.1007/s11739-023-03197-9</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-1101-1066</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1828-0447 |
| ispartof | Internal and emergency medicine, 2023-06, Vol.18 (4), p.1159-1168 |
| issn | 1828-0447 1970-9366 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10326134 |
| source | SpringerLink Journals |
| subjects | Adverse events Comorbidity Congestive heart failure EM - Original Emergency medical care Heart failure Hospitalization Internal Medicine Medicine Medicine & Public Health Mortality |
| title | Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes |
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