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.

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 <2% (ou...

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Detalles Bibliográficos
Autores: Miró Ò, López-Díez MP, Rossello X, Gil V, Herrero P, Jacob J, Llorens P, Escoda R, Aguiló S, Alquézar A, Tost J, Valero A, Gil C, Garrido JM, Alonso H, Lucas-Invernón FJ, Torres-Murillo J, Raquel-Torres-Gárate, Mecina AB, Traveria L, Agüera C, Takagi K, Möckel M, Pang PS, Collins SP, Mueller CE, Martín-Sánchez FJ, ICA-SEMES Research Group
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
Repositorio:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
OAI Identifier:oai:isabial.fundanetsuite.com:p6842
Acceso en línea:https://isabial.portalinvestigacion.com/publicaciones6842
https://reader.elsevier.com/reader/sd/pii/S0914508720303075?token=3A8BFCCF4E625344D621D5C82E482B0E0491D46EB077FC8357B8F5C93BBD107FC64B32DA201102B3CF696E4CB4D8995C&originRegion=eu-west-1&originCreation=20220321132340
Access Level:acceso abierto
Palabra clave:Acute heart failure
Emergency department
Outcomes
Quality
Descripción
Sumario: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 <2% (outcome A); 7-day ED revisit due to AHF < 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 R(2) = 0.184/0.322) and C (weighted R(2) = 0.430/0.624), but not with outcome A (weighted R(2) = 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.

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