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

Miró, Òscar; López-Díez, María Pilar; Rosselló, Xavier; Gil, Víctor; Herrero, Pablo; Jacob, Javier; Llorens, Pere; Escoda, Rosa; Aguiló, Sira; Alquézar, Aitor; Tost, Josep; Valero, Amparo; Gil, Cristina; Garrido, José Manuel; Alonso, Héctor; Lucas-Invernón, Francisco Javier; Torres-Murillo, José; Torres-Gárate, R.; Traveria, Lissette; Agüera, Carmen; Takagi, Koji; Möckel, Martin; Pang, Peter S.; Collins, Sean P.; Mueller, Christian; Martín‐Sánchez, Francisco Javier; Fuentes, Marta; Pérez‐Llantada, Enrique; García, Guillermo; Cadenas, Mar Suárez; Sánchez, Carolina; Pérez‐Durá, María José; Salvo, Eva; Pavón, José; Noval, Antonio; Torres, José Manuel; López‐Grima, María Luisa; Juan, María Ángeles; Aguirre, Alfons; Pedragosa, María Àngels; Masó, Silvia Mínguez; Alonso, María Isabel; Ruiz, Francisco; Franco, José Miguel; Mecina, Ana Belén; Berenguer, Marta; Donea, Ruxandra; Ramón, Susana Sánchez; Rodríguez, Virginia Carbajosa; Piñera, Pascual; Nicolás, José Andrés Sánchez; Garate, Raquel Torres; Alquézar‐Arbé, Aitor; Rizzi, Miguel Alberto; Herrera, Sergio; Roset, Álex; Cabello, Irene; Haro, Antonio; Richard, Fernando; Pérez, José María Álvarez; Díez, María Pilar López; Puente, Pablo Herrero; Álvarez, Joaquín Vázquez; García, Belén Prieto; García, María García; González, Marta Sánchez; Javaloyes, Patricia; Marquina, Víctor; Jiménez, Inmaculada; Hernández, Néstor; Brouzet, Benjamín; Espinosa, B.; Gil, Adriana; Andueza, Juan Antonio; Romero, Rodolfo; Ruíz, Martín; Calvache, Roberto; Serralta, María Teresa Lorca; Jave, Luis Ernesto Calderón; Arriaga, Beatriz Amores; Bergua, Beatriz Sierra; Mojarro, Enrique Martín; Jiménez, Brigitte Silvana Alarcón; Bécquer, Lisette Travería; Burillo, Guillermo; García, Lluís Llauger; LaSalle, Gerard Corominas; Urbano, Carmen Agüera; Soto, Ana Belén García; Padial, Elisa Delgado; Ferrer, Ester Soy; Múñoz, María Adroher; Lucas-Imbernón, Francisco Javier; Gaya, Rut; Bibiano, Carlos; Mir, María; Rodríguez, Beatriz; Carballo, José Luís; Rodríguez‐Adrada, Esther; Miranda, Belén Rodríguez; Martín, Monika Vicente; Casanova, Pere Coma; Alvarós, J.

doi:10.1016/j.jjcc.2020.09.002

Cited by 8 publications

(3 citation statements)

References 23 publications

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“…8,10 In addition, a secondary analysis of a large Spanish cohort of ED patients with heart failure found that nearly 30% of patients discharged directly from the ED returned within 30 days. 54 It is unclear whether patients discharged from the ED who experience adverse outcomes might have benefited from hospitalization during their initial presentation. Several notable studies have sought to risk stratify AHF ED patients and identify those at high risk for short-term adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure

Kilaru

Illenberger

Meisel

et al. 2022

Circ: Cardiovascular Quality and Outcomes

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Background: Patients who are discharged from the emergency department (ED) after an encounter for acute heart failure are at high risk for return hospitalization. These patients may benefit from timely outpatient follow-up care to reassess volume status, adjust medications, and reinforce self-care strategies. This study examines the incidence of outpatient follow-up care after ED encounters for acute heart failure and describes patient characteristics associated with obtaining timely follow-up care. Methods: We conducted a retrospective cohort study using an administrative claims database for a large US commercial insurer, from January 1, 2012 to June 30, 2019. Participants included adult patients discharged from the ED with principal diagnosis of acute heart failure. The primary outcome was obtaining an in-person outpatient clinic visit for heart failure within 30 days. We also examined the competing risk of all-cause hospitalization within 30 days and without an intervening outpatient clinic visit. We estimated competing risk regression models to identify patient characteristics associated with obtaining outpatient follow-up and report cause-specific hazard ratios. Results: The cohort included 52 732 patients, with mean age of 73.9 years (95% CI, 73.8–74.0) and 27 395 (52.0% [95% CI, 51.5–52.4]) female patients. Within 30 days of the ED encounter, 12 279 (23.2%) patients attended an outpatient clinic visit for heart failure, with 8382 (15.9%) patients hospitalized before they could obtain an outpatient clinic visit. In the adjusted analysis, patients that were younger, women, reporting non-Hispanic Black race, and had fewer previous clinic visits were less likely to obtain outpatient follow-up care. Conclusions: Few patients obtain timely outpatient follow-up after ED visits for heart failure, although nearly 20% require hospitalization within 30 days. Improved transitions following discharge from the ED may represent an opportunity to improve outcomes for patients with acute heart failure.

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Section: Discussionmentioning

confidence: 99%

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure

Kilaru

Illenberger

Meisel

et al. 2022

Circ: Cardiovascular Quality and Outcomes

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“…Perhaps, this cautious management may have influenced this outcome, as clinical variables such as persistent congestion or renal dysfunction are likely to be better controlled with longer periods of hospitalization. Moreover, patients discharged directly from the ED are more likely to be revisited or hospitalized, but not to die, in the short term [38].…”

Section: Discussionmentioning

confidence: 99%

Impact of worsening renal function detected at emergency department arrival on acute heart failure short-term outcomes

Llauger

Espinosa

Rafique

et al. 2023

European Journal of Emergency Medicine

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Background and importance Deterioration of renal function with respect to baseline during an acute heart failure (AHF) episode is frequent, but impact on outcomes is still a matter of debate. Objective To investigate the association of creatinine deterioration detected at emergency department (ED) arrival and short-term outcomes in patients with AHF. Design Secondary analysis of a large multipurpose registry. Settings and participants Patients with AHF were diagnosed in 10 Spanish ED for whom a previous baseline creatinine was available. Exposure Difference between creatinine at ED arrival and at baseline was calculated (∂-creatinine). Outcome measures and analysis Primary outcome was 30-day all-cause death, and secondary outcomes were inhospital all-cause death, prolonged hospitalization (>7 days) and 7-day postdischarge adverse events. Associations between ∂-creatinine and outcomes were explored using logistic regression by restricted cubic spline (RCS) curves and expressed as odds ratio (OR) with 95% confidence interval (CI), taking ∂-creatinine = 0 mg/dl as reference. Curves were adjusted by age, sex, comorbidities, patient baseline status, chronic treatments, and vitals and laboratory results at ED arrival. Interactions for the primary outcome also were investigated. Main results We analyzed 3036 patients (median age = 82 years; IQR = 75–87; women = 55%), with ∂-creatinine ranged from −0.3 to 3 mg/dl. The 30-day mortality was 11.6%. Increments of ∂-creatinine were associated with progressive increase in risk of 30-day death, although adjustment attenuated this association: ∂-creatinine of 0.3/1/2/3 mg/dl were, respectively, associated with adjusted OR of 1.41 (1.02–1.95), 1.69 (1.02–2.80), 1.46 (0.56–3.80) and 1.27 (0.27–5.83). Distinctively significant higher risk was found for patients over 80 years old, female, nondiabetic, functionally disabled and on digoxin therapy. With respect to secondary outcomes, inhospital mortality was 8.1%, prolonged hospitalization was 33.6% and 7-day postdischarge adverse event was 9.7%. Inhospital death steadily increased with increments in ∂-creatinine [from 1.50 (1.04–2.17) with ∂-creatinine = 0.3 to 3.78 (0.78–18.3) with ∂-creatinine = 3], as well as prolonged hospitalization did [from 1.41 (1.11–1.77) to 2.24 (1.51–3.33), respectively]. Postdischarge adverse events were not associated with ∂-creatinine. Conclusion WRF detected at ED arrival has prognostic value in AHF, being associated with increased risk of death and prolonged hospitalization. These associations showed different patterns of risk but, remarkably, risk started with increments as low as 0.3 mg/dl.

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“…It is well described that hospitalization rates demonstrate great variability in clinical practice, from country to country, and even from ED to ED [26]. They are highly influenced by subjective perceptions and sometimes hospitalization rates may not match the severity of decompensation in individual patients [27].…”

Section: Discussionmentioning

confidence: 99%

QT interval and short-term outcome in acute heart failure

et al. 2023

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Objective To investigate the association of corrected QT (QTc) interval duration and short-term outcomes in patients with acute heart failure (AHF). Methods We analyzed AHF patients enrolled in 11 Spanish emergency departments (ED) for whom an ECG with QTc measurement was available. Patients with pace-maker rhythm were excluded. Primary outcome was 30-day all-cause mortality and secondary outcomes were need of hospitalization, in-hospital mortality and prolonged hospitalization (> 7 days). Association between QTc and outcomes was explored by restricted cubic spline (RCS) curves. Results were expressed as odds ratios (OR) and 95%CI adjusted by patients baseline and decompensation characteristics, using a QTc = 450 ms as reference. Results Of 1800 patients meeting entry criteria (median age 84 years (IQR = 77–89), 56% female), their median QTc was 453 ms (IQR = 422–483). The 30-day mortality was 9.7%, while need of hospitalization, in-hospital mortality and prolonged hospitalization were 77.8%, 9.0% and 50.0%, respectively. RCS curves found longer QTc was associated with 30-day mortality if > 561 ms, OR = 1.86 (1.00–3.45), and increased up to OR = 10.5 (2.25–49.1), for QTc = 674 ms. A similar pattern was observed for in-hospital mortality; OR = 2.64 (1.04–6.69), for QTc = 588 ms, and increasing up to OR = 8.02 (1.30–49.3), for QTc = 674 ms. Conversely, the need of hospitalization had a U-shaped relationship: being increased in patients with shorter QTc [OR = 1.45 (1.00–2.09) for QTc = 381 ms, OR = 5.88 (1.25–27.6) for the shortest QTc of 200 ms], and also increasing for prolonged QTc [OR = 1.06 (1.00–1.13), for QTc = 459 ms, and reaching OR = 2.15 (1.00–4.62) for QTc = 588 ms]. QTc was not associated with prolonged hospitalization. Conclusion In ED AHF patients, initial QTc provides independent short-term prognostic information, with increasing QTc associated with increasing mortality, while both, shortened and prolonged QTc are associated with need of hospitalization. Graphical abstract

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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

Cited by 8 publications

References 23 publications

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure

Impact of worsening renal function detected at emergency department arrival on acute heart failure short-term outcomes

QT interval and short-term outcome in acute heart failure

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