Rates and predictive factors of return to the emergency department following an initial release by the emergency department for acute heart failure

Claret, Pierre‐Géraud; Calder, Lisa A.; Stiell, Ian G.; Yan, Justin; Clement, Catherine M.; Borgundvaag, Bjug; Forster, Alan J.; Perry, Jeffrey J.; Rowe, Brian H.

doi:10.1017/cem.2017.14

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…ED visits for HF compose nearly 1% of all ED visits in the United States, carry high economic costs, and are associated with high rates of hospitalization and recidivism. 27–29 A previous Kaiser Permanente Southern California and Northwest study found higher ED visit rates in HFpEF patients when compared with HFrEF and HFbEF patients. 7 However, this study did not identify HF-related ED visits, included a smaller cohort of patients followed only after an index HF hospitalization, and excluded HFbEF patients.…”

Section: Discussionmentioning

confidence: 98%

Long-Term Outcomes of Adults With Heart Failure by Left Ventricular Systolic Function Status

Avula

Leong

Lee

et al. 2018

The American Journal of Cardiology

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Patients with heart failure (HF) and preserved (HFpEF) or borderline preserved ejection fraction (HFbEF) outnumber patients with HF and reduced ejection fraction (HFrEF), but limited data exist on outcomes in community-based populations of these patients. We examined clinical outcomes in a diverse population of adults with HFrEF, HFbEF, and HFpEF. All adults with diagnosed HF from 2005 to 2012 in Kaiser Permanente Northern California were categorized by left ventricular systolic function as HFpEF (EF ≥50%), HFbEF (EF 41-49%), or HFrEF (EF ≤40%). Demographics, clinical characteristics, and therapies were obtained from electronic records. Outcomes included death, HF hospitalization, and HF-related emergency department (ED) visit. In 28,914 eligible HF patients, there were 52% HFpEF, 16% HFbEF, and 32% HFrEF, with mean age 72.8 years and 45% women. During median follow-up of 3.5 years, crude rates (per 100 person-years) of death, HF hospitalization, and HF-related ED visit were 14.5 (95% CI 14.3 to 14.7), 15.8 (15.5 to 16.0), and 38.2 (37.8 to 38.5), respectively. Compared with HFrEF patients, adjusted hazard ratios of death, HF hospitalization, and HF-related ED visit for HFpEF patients were 0.82 (0.79 to 0.85), 0.72 (0.68 to 0.75), and 0.94 (0.90 to 0.99), respectively, and for HFbEF patients were 0.84 (0.79 to 0.88), 0.79 (0.73 to 0.84), and 0.90 (0.84 to 0.96), respectively. In conclusion, within a large community-based HF cohort, adjusted rates of death, HF hospitalization, and HF-related ED visits were similar in HFpEF and HFbEF patients, but higher in HFrEF patients. Regardless of systolic function, however, long-term mortality and morbidity in all HF patients remain high, reinforcing the need for novel strategies to improve long-term outcomes.

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Section: Discussionmentioning

confidence: 98%

Long-Term Outcomes of Adults With Heart Failure by Left Ventricular Systolic Function Status

Avula

Leong

Lee

et al. 2018

The American Journal of Cardiology

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“…The rate of return to emergency services by patients with heart failure was 20% in a Canadian study. 19 In another investigation, patients with this diagnosis and aged ≥80 years were significantly more prone to returning, when compared to younger individuals. 20 Still, in both studies, the use of antiarrhythmic medications was negatively associated with the occurrence of the outcome.…”

Section: Discussionmentioning

confidence: 92%

“…20 Still, in both studies, the use of antiarrhythmic medications was negatively associated with the occurrence of the outcome. 19 , 20…”

Section: Discussionmentioning

confidence: 99%

“…A taxa de retorno a serviços de emergência por pacientes com insuficiência cardíaca foi de 20% em estudo canadense. 19 Em outra investigação, pacientes com esse diagnóstico apresentando idade ≥80 anos eram significativamente mais propensos ao retorno, se comparados àqueles com idade inferior. 20 Ainda, em ambos os estudos, o uso de medicamentos antiarrítmicos esteve associado negativamente à ocorrência do desfecho.…”

Section: Discussionunclassified

“…20 Ainda, em ambos os estudos, o uso de medicamentos antiarrítmicos esteve associado negativamente à ocorrência do desfecho. 19 , 20…”

Section: Discussionunclassified

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Emergency department visits of older adults within 30 days of discharge: analysis from the pharmacotherapy perspective

Santos¹,

Dias²,

Reis³

2019

Einstein (São Paulo)

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Objective To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge.Methods A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit.Results A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023).Conclusion The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.

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Prediction of oxygen requirement in patients with COVID-19 using a pre-trained chest radiograph xAI model: efficient development of auditable risk prediction models via a fine-tuning approach

Chung

Kim

Choi

et al. 2022

Sci Rep

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Risk prediction requires comprehensive integration of clinical information and concurrent radiological findings. We present an upgraded chest radiograph (CXR) explainable artificial intelligence (xAI) model, which was trained on 241,723 well-annotated CXRs obtained prior to the onset of the COVID-19 pandemic. Mean area under the receiver operating characteristic curve (AUROC) for detection of 20 radiographic features was 0.955 (95% CI 0.938–0.955) on PA view and 0.909 (95% CI 0.890–0.925) on AP view. Coexistent and correlated radiographic findings are displayed in an interpretation table, and calibrated classifier confidence is displayed on an AI scoreboard. Retrieval of similar feature patches and comparable CXRs from a Model-Derived Atlas provides justification for model predictions. To demonstrate the feasibility of a fine-tuning approach for efficient and scalable development of xAI risk prediction models, we applied our CXR xAI model, in combination with clinical information, to predict oxygen requirement in COVID-19 patients. Prediction accuracy for high flow oxygen (HFO) and mechanical ventilation (MV) was 0.953 and 0.934 at 24 h and 0.932 and 0.836 at 72 h from the time of emergency department (ED) admission, respectively. Our CXR xAI model is auditable and captures key pathophysiological manifestations of cardiorespiratory diseases and cardiothoracic comorbidities. This model can be efficiently and broadly applied via a fine-tuning approach to provide fully automated risk and outcome predictions in various clinical scenarios in real-world practice.

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Rates and predictive factors of return to the emergency department following an initial release by the emergency department for acute heart failure

Abstract: Many heart failure patients (i.e. 1 in 5 patients) are released from the ED and then suffer return to ED. Patients with multiple medical comorbidities, and those with abnormal initial vital signs are at increased risk for return to ED and should be identified.

Cited by 5 publications

References 23 publications

Long-Term Outcomes of Adults With Heart Failure by Left Ventricular Systolic Function Status

Long-Term Outcomes of Adults With Heart Failure by Left Ventricular Systolic Function Status

Emergency department visits of older adults within 30 days of discharge: analysis from the pharmacotherapy perspective

Prediction of oxygen requirement in patients with COVID-19 using a pre-trained chest radiograph xAI model: efficient development of auditable risk prediction models via a fine-tuning approach

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