OUTCOMES
AFTER EMERGENCY DEPARTMENT DISCHARGE WITH A PRIMARY DIAGNOSIS OF HEART FAILURE.
Rame
JE, et al. Am Heart J 2001 Oct;142(4):714-9
BACKGROUND:
Patients with decompensated chronic heart failure (CHF) are frequently
evaluated in emergency departments (ED). The outcomes of such patients after
discharge to the outpatient setting from the ED are not well known. Risk
factors for return ED visits or subsequent hospital admission after ED discharge
for CHF also are not known.
METHODS:
Charts were reviewed from all 112 patients discharged from the Parkland
Memorial Hospital ED with a primary diagnosis of CHF from October to December
1998. A composite end point ("failure of outpatient therapy") was
prespecified to be a recurrent ED visit for CHF, hospitalization for CHF, or
death at 3 months after the index ED discharge.
RESULTS:
Within 3 months of the index ED visit, 61% of the study population met the
composite end point. The median time to failure of outpatient therapy was 30
days. Univariate analysis of 27 clinical and demographic variables demonstrated
the respiratory rate at presentation as the only predictor of failure of
outpatient therapy (P =.02). Multivariate analysis of a model with 8
prespecified variables also demonstrated respiratory rate to be the only
variable independently associated with an increased risk for the composite end
point (odds ratio 1.6, 95% confidence interval 1.1-2.6, for each increase of 5
breaths/min).
CONCLUSION:
There is a high rate of failure of outpatient therapy (61%) in patients
discharged with a primary diagnosis of CHF from an urban county hospital ED.
Increased respiratory rate on presentation to the ED may be associated with
adverse outcomes after ED discharge for CHF.