Source: DGNews  |  Posted 2 years ago

EDMONTON, Alberta -- October 29, 2009 -- Patients with heart failure who are
discharged from the emergency room (ER) have a substantially increased risk of
early death compared with those who are admitted -- even among patients with
comparable degrees of heart failure, according to researchers at the 2009
Canadian Cardiovascular Congress (CCC).

An analysis of medical records from more than 50,000 heart-failure patients
demonstrated that the 90-day mortality among patients was almost a third higher
(12.4% vs 9.4%) for those discharged from the ER compared with those admitted
to hospital (P < .001). The data were presented here on October 26.

“The rates of early death among those who are not admitted to hospital exceeds
that of hospitalised patients with comparable predictive mortality risk --
suggesting that we may need better algorithms for evaluating patients in the
emergency department,” reported Douglas S. Lee, MD, PhD, Institute for Clinical
Evaluative Sciences, Toronto, Ontario, Canada.

Some of the variables characterising those more likely to be admitted -- such
as a high triage acuity score or older age -- make sense, Dr. Lee noted, but
others, such as arrival by ambulance or resuscitation in the ER, appear to be
more driven by a subjective sense of disease severity.

Over a 3-year period (April 2004 through March 2007), 50,816 patients in the
province of Ontario, Canada, visited an emergency department because of heart
failure. Of these patients, 16,094 (31.7%) were discharged without hospital
admission. The odds ratio (OR) for being admitted increased by 8% for each
decade of life but doubled (OR = 2.02) if the patient arrived by ambulance and
almost tripled (OR = 2.85) if an emergency-room resuscitation was administered.
A high triage acuity score increased the likelihood of admission by more than 4
fold (OR = 4.12).

The mortality risk in the discharged patients was significantly increased at 90
days whether patients were stratified by predicted likelihood of mortality over
7 days or over 30 days.

These data are potentially important, because this is an issue that has not
been well studied previously, Dr. Lee noted. Given the important differences in
outcome for those discharged in this study, the current decision-making process
about when to admit patients and when to allow them to return home appears to
be suboptimal.

Although this was an observational study, Dr. Lee suggested that studies to
formalise and improve algorithms for admitting or discharging heart-failure
patients presenting in the ER appear to be needed.

CCC is co-hosted by the Canadian Cardiovascular Society and the Heart and
Stroke Foundation of Canada.

Presentation title: Population-Based Evaluation of Mortality of Heart
Failure Patients Discharged From the Emergency Department. Abstract 556