Preliminary experience with an emergency department observation unit protocol for heart failure

Area of Science:

• Cardiology
• Emergency Medicine
• Health Services Research

Background:

• Most emergency department (ED) patients with congestive heart failure (CHF) are hospitalized.
• An ED-based observation unit protocol could offer an alternative management strategy for select CHF patients.
• The natural history and outcomes of CHF patients managed in such a unit are not well-described.

Purpose of the Study:

• To describe the natural history of patients with congestive heart failure (CHF) managed in an ED-based observation unit.
• To assess clinical improvements, length of hospital stay (LOS), morbidity, mortality, and readmission rates in this cohort.

Main Methods:

• Screened ED patients presenting with CHF symptoms between July 1999 and December 1999.
• Excluded patients with hemodynamic instability, respiratory failure, acute myocardial infarction, new-onset heart failure, or severe comorbidities.
• Managed eligible patients in an observation unit for up to 12 hours, monitoring heart rate (HR), respiratory rate (RR), diuresis, and clinical severity (GACS); followed for 30-day outcomes.

Main Results:

• Twenty-four low-risk CHF patients were enrolled; most showed reduced HR and RR by 4 hours, and improved GACS by 12 hours.
• By 12 hours, a majority achieved significant diuresis (>1500 mL).
• Median inpatient LOS was brief (1 day); no deaths or adverse events occurred within 30 days, with 2 of 4 readmissions related to CHF.

Conclusions:

• Most low-risk CHF patients managed in an ED observation unit demonstrated clinical improvement within 6-12 hours.
• This observation unit protocol appears safe for this selected group.
• Further research is warranted to confirm if this approach can effectively reduce hospital LOS.