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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

Abstract: Objective: Experts recommended that direct discharge without hospitalization (DDWH) for emergency departments (EDs) able to observe acute heart failure (AHF) patients should be >40%, and these discharged patients should fulfil the following outcome standards: 30-day all-cause mortality < 10% (outcome B); and 30-day ED revisit/hospitalization due to AHF < 20% (outcome C). We investigated these outcomes in a nationwide cohort and their relationship with the ED DDWH percentage. Methods: We analyzed the EAHFE registry (includes about 15% of Spanish EDs), calculated DDWH percentage of each ED, and A/B/C outcomes of DDWH patients, overall and in each individual ED. Relationship between ED DDWH and outcomes was assessed by linear and quadratic regression models, non-weighted and weighted by DDWH patients provided by each ED. Results: Among 17,420 patients, 4488 had DDWH (25.8%, median ED stay = 0 days, IQR = 0?1). Only 12.9% EDs achieved DDWH > 40%. Considering DDWH patients altogether, outcomes A/C were above the recommended standards (4.3%/29.4%), while outcome B was nearly met (B = 10.1%). When analyzing individual EDs, 58.1% of them achieved the outcome B standard, while outcomes A/C standards were barely achieved (19.3%/9.7%). We observed clinically relevant linear/quadratic relationships between higher DDWH and worse outcomes B (weighted R2 = 0.184/0.322) and C (weighted R2 = 0.430/0.624), but not with outcome A (weighted R2 = 0.002/0.022). Conclusions: The EDs of this nationwide cohort do not fulfil the standards for AHF patients with DDWH. High DDWH rates negatively impact ED revisit or hospitalization but not mortality. This may represent an opportunity for improvement in better selecting patients for early ED discharge and in ensuring early follow-up after ED discharge

 Fuente: Journal of Cardiology Volume 77, Issue 3, March 2021, Pages 245-253

Editorial: Elsevier

 Fecha de publicación: 01/03/2021

Nº de páginas: 9

Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.jjcc.2020.09.002

ISSN: 0914-5087,1876-4738

Url de la publicación: https://doi.org/10.1016/j.jjcc.2020.09.002

Autores/as

MIRÓ, ÒSCAR

LÓPEZ-DÍEZ, MARÍA PILAR

ROSSELL, XAVIER

GIL, VÍCTOR

HERRERO, PABLO

JACOB, JAVIER

LLORENS, PERE

ESCODA, ROSA

AGUILÓ, SIRA

ALQUÉZAR, AITOR

TOST, JOSEP

VALERO, AMPARO

GIL, CRISTINA

GARRIDO, JOSÉ MANUEL

LUCAS-INVERNÓN, FRANCISCO JAVIER

TORRES-MURILLO, JOSÉ

TORRES-GÁRATE, RAQUEL

MECINA, ANA B.

TRAVERIA, LISSETTE