IMPROV-ED study: outcomes after discharge for an episode of acute-decompensated heart failure and comparison between patients discharged from the emergency department and hospital wards

Miró, Òscar; Gil, Víctor; Xipell, Carolina; Sánchez, Carolina; Aguiló, Sira; Martín‐Sánchez, Francisco Javier; Herrero, Pablo; Jacob, Javier; Mebazaa, Alexandre; Harjola, Veli‐Pekka; Llorens, Pere

doi:10.1007/s00392-016-1065-y

Cited by 16 publications

(6 citation statements)

References 31 publications

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“…19,20 In this regard, between one-sixth and one-third of AHF patients diagnosed at ED presentation are discharged home without hospitalization worldwide 21 and these patients have poorer outcomes when compared with patients managed by admission to hospital. 22–24 The lack of risk stratification of AHF patients before ED decision-making has been identified as one of the reasons explaining the difference in clinical outcomes between directly discharged and hospitalised patients. 25,26 Risk stratification is helping to make safer decisions in other highly prevalent, severe ED illnesses, and scores specifically developed for that use are available for pneumonia (Pneumonia Severity Index, CURB-65), 27,28 acute coronary syndrome (GRACE, HEART) 29,30 and sepsis (qSOFA and SOFA) 31,32 Several scores achieving reliable risk stratification in patients with AHF have been reported during the last decade, though risk assessment seems not to be systematically performed as part of routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review

Miró

Rosselló

Platz

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Aims This study aimed to systematically identify and summarise all risk scores evaluated in the emergency department setting to stratify acute heart failure patients. Methods and results A systematic review of PubMed and Web of Science was conducted including all multicentre studies reporting the use of risk predictive models in emergency department acute heart failure patients. Exclusion criteria were: (a) non-original articles; (b) prognostic models without predictive purposes; and (c) risk models without consecutive patient inclusion or exclusively tested in patients admitted to a hospital ward. We identified 28 studies reporting findings on 19 scores: 13 were originally derived in the emergency department (eight exclusively using acute heart failure patients), and six in emergency department and hospitalised patients. The outcome most frequently predicted was 30-day mortality. The performance of the scores tended to be higher for outcomes occurring closer to the index acute heart failure event. The eight scores developed using acute heart failure patients only in the emergency department contained between 4–13 predictors (age, oxygen saturation and creatinine/urea included in six scores). Five scores (Emergency Heart Failure Mortality Risk Grade, Emergency Heart Failure Mortality Risk Grade 30 Day mortality ST depression, Epidemiology of Acute Heart Failure in Emergency department 3 Day, Acute Heart Failure Risk Score, and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) have been externally validated in the same country, and two (Emergency Heart Failure Mortality Risk Grade and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) further internationally validated. The c-statistic for Emergency Heart Failure Mortality Risk Grade to predict seven-day mortality was between 0.74–0.81 and for Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure to predict 30-day mortality was 0.80–0.84. Conclusions There are several scales for risk stratification of emergency department acute heart failure patients. Two of them are accurate, have been adequately validated and may be useful in clinical decision-making in the emergency department i.e. about whether to admit or discharge.

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Section: Introductionmentioning

confidence: 99%

Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review

Miró

Rosselló

Platz

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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“…A patient with severe breathlessness at rest in acute pulmonary oedema is a medical emergency requiring immediate investigation and treatment [ 4 , 5 ]. A patient presenting with increasing exertional breathlessness and worsening peripheral oedema might be considered sub-acute and requiring treatment within hours or days rather than minutes [ 6 , 7 ]. If the target and purpose of therapy is diverse then trials that treat all AHF as a single entity are likely to fail.…”

Section: Introductionmentioning

confidence: 99%

Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey

et al. 2018

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Background Heart failure is heterogeneous in aetiology, pathophysiology, and presentation. Despite this diversity, clinical trials of patients hospitalized for HF deal with this problem as a single entity, which may be one reason for repeated failures. Methods The first EuroHeart Failure Survey screened consecutive deaths and discharges of patients with suspected heart failure during 2000–2001. Patients were sorted into seven mutually exclusive hierarchical presentations: (1) with cardiac arrest/ventricular arrhythmia; (2) with acute coronary syndrome; (3) with rapid atrial fibrillation; (4) with acute breathlessness; (5) with other symptoms/signs such as peripheral oedema; (6) with stable symptoms; and (7) others in whom the contribution of HF to admission was not clear. Results The 10,701 patients enrolled were classified into the above seven presentations as follows: 260 (2%), 560 (5%), 799 (8%), 2479 (24%), 1040 (10%), 703 (7%), and 4691 (45%) for which index-admission mortality was 26%, 20%, 10%, 8%, 6%, 6%, and 4%, respectively. Compared to those in group 7, the hazard ratios for death during the index admission were 4.9 ( p ≤ 0.001), 4.0 ( p < 0.001), 2.2 ( p < 0.001), 2.1 ( p < 0.001), 1.4 ( p < 0.04) and 1.4 ( p = 0.04), respectively. These differences were no longer statistically significant by 12 weeks. Conclusion There is great diversity in the presentation of heart failure that is associated with very different short-term outcomes. Only a minority of hospitalizations associated with suspected heart failure are associated with acute breathlessness. This should be taken into account in the design of future clinical trials.

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“…Unfortunately, AHF patients are at high risk for adverse outcomes even when they are discharged from the ED, including death and rehospitalization. 8-14 After an ED visit, patients require time-sensitive outpatient management, including assessment of volume status, medication adjustment, and reinforcement of self-care strategies. 15,16 Early follow-up care for AHF has been shown to improve outcomes after hospital discharge.…”

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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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IMPROV-ED study: outcomes after discharge for an episode of acute-decompensated heart failure and comparison between patients discharged from the emergency department and hospital wards

Cited by 16 publications

References 31 publications

Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review

Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review

Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey

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

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