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
Por:
Miro, O, Lopez-Diez, MP, Rossello, X, Gil, V, Herrero, P, Acob, J, Llorens, P, Escoda, R, Aguilo, S, Alquezar, A, Tost, J, Valero, A, Gil, C, Garrido, JM, Alonso, H, Lucas-Invernon, FJ, Torres-Murillo, J, Raquel-Torres-Garate, Mecina, AB, Traveria, L, Aguera, C, Takagi, K, Mockel, M, Pang, PS, Collins, SP, Mueller, CE, Martin-Sanchez, FJ, ICA-SEMES Res Grp
Publicada:
1 mar 2021
Ahead of Print:
12 oct 2020
Resumen:
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. (c) 2020 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.
Filiaciones:
Miro, O:
Univ Barcelona, Emergencies Proc & Pathol Res Grp, IDIBAPS, Emergency Dept,Hosp Clin, Barcelona, Catalonia, Spain
Lopez-Diez, MP:
Hosp Univ Burgos, Emergency Dept, Av Islas Baleares 3, Burgos 09006, Spain
Rossello, X:
Hosp Univ Son Espases, Cardiol Dept, Palma De Mallorca, Spain
Gil, V:
Univ Barcelona, Emergencies Proc & Pathol Res Grp, IDIBAPS, Emergency Dept,Hosp Clin, Barcelona, Catalonia, Spain
Herrero, P:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Spain
Acob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Catalonia, Spain
Llorens, P:
Hosp Gen Alicante, Home Hospitalizat & Short Stay Unit, Emergency Dept, Alicante, Spain
Escoda, R:
Univ Barcelona, Emergencies Proc & Pathol Res Grp, IDIBAPS, Emergency Dept,Hosp Clin, Barcelona, Catalonia, Spain
Aguilo, S:
Univ Barcelona, Emergencies Proc & Pathol Res Grp, IDIBAPS, Emergency Dept,Hosp Clin, Barcelona, Catalonia, Spain
Alquezar, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Catalonia, Spain
Tost, J:
Hosp Terrassa, Emergency Dept, Barcelona, Catalonia, Spain
Valero, A:
Hosp Dr Peset, Emergency Dept, Valencia, Spain
Gil, C:
Hosp Univ Salamanca, Emergency Dept, Salamanca, Spain
Garrido, JM:
Hosp Virgen Macarena, Emergency Dept, Seville, Spain
Alonso, H:
Hosp Univ Marques Valdecilla, Emergency Dept, Santander, Spain
Lucas-Invernon, FJ:
Hosp Gen Albacete, Emergency Dept, Albacete, Spain
Torres-Murillo, J:
Hosp Univ Nuestra Senora Valme, Emergency Dept, Seville, Spain
Raquel-Torres-Garate:
Hosp Severo Ochoa, Emergency Dept, Madrid, Spain
Mecina, AB:
Hosp Univ Fdn Alcorcon, Emergency Dept, Madrid, Spain
Traveria, L:
Hosp Univ Canarias, Emergency Dept, Tenerife, Spain
Aguera, C:
Hosp Costa Sol, Emergency Dept, Malaga, Spain
Takagi, K:
Kosugi Hosp, Nippon Med Sch Musashi, Cardiol & Intens Care Unit, Kawasaki, Kanagawa, Japan
INSERM, UMR S 942, Paris, France
Mockel, M:
Charite Univ Med Berlin, Campus ChariteMitte & VirchowKlinikum, Div Emergency & Acute Med, Cardiol Dept, Berlin, Germany
Pang, PS:
Indiana Univ Sch Med, Emergency Dept, Indianapolis, IN 46202 USA
Collins, SP:
Vanderbilt Univ, Sch Med, Emergency Dept, Nashville, TN 37212 USA
Mueller, CE:
Univ Basel, Univ Hosp Basel, Basel, Switzerland
Martin-Sanchez, FJ:
Univ Complutense Madrid, Inst Invest Sanitaria San Carlos IdISSC, Hosp Clin San Carlos Madrid, Emergency Dept, Madrid, Spain
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