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Effective observation unit treatment of decompensated heart failure
William Franklin Peacock1, Erica E Remer, Josef Aponte
1Cleveland Clinic Foundation, Cleveland, OH 44195, USA. peacocw@ccf.org
Insights
Implementing an emergency department (ED) observation unit (OU) protocol for heart failure (HF) significantly reduced 90-day revisits and hospitalizations. This HF management strategy improves patient outcomes after acute exacerbations.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Limited data exists on the effectiveness of emergency department (ED) observation unit (OU) therapies for heart failure (HF).
- Evaluating outcomes of a structured protocol for HF exacerbation management in an ED-OU setting is crucial.
Purpose of the Study:
- To assess the effectiveness of an implemented ED-OU treatment protocol for heart failure (HF) exacerbation.
- To compare adverse outcomes before and after the protocol's initiation.
Main Methods:
- An unblinded assessment of an HF protocol, including diagnostic and therapeutic algorithms, cardiology consultation, monitoring, education, and discharge planning.
- Adverse outcomes (90-day ED HF revisits, hospital HF readmissions, or death) were tracked via chart review, database searches, and phone follow-up.
- A cohort of 154 patients (50 pre-protocol, 104 post-protocol) was analyzed.
Main Results:
- Post-protocol, 90-day ED HF revisit rates decreased by 56% (0.90 to 0.51, p<0.0000).
- The 90-day HF rehospitalization rate decreased by 64% (0.77 to 0.50, p=0.007).
- Rates of death and OU HF readmission showed a downward trend (4% to 1% and 18% to 11%, respectively).
Conclusions:
- An intensive outpatient ED OU HF management protocol safely and effectively decreases 90-day adverse outcomes.
- The protocol implementation led to significant reductions in emergency department visits and inpatient hospitalizations for heart failure.
- This structured approach enhances patient care and resource utilization for heart failure exacerbations.
Abstract:
There is little information on the effectiveness of emergency department (ED) observation unit (OU) heart failure (HF) therapy. The authors' objective was to evaluate outcomes after implementation of an ED-OU treatment protocol for HF exacerbation. Unblinded assessment of the effectiveness of an HF protocol was performed, controlled by outcome for 9 months prior to implementation. This included diagnostic and therapeutic algorithms, cardiology consultation, close monitoring, patient education, and discharge planning. Adverse outcomes were defined as the 90-day rates of ED HF revisits, hospital HF readmissions, or death, as determined by chart review, computer database search, and phone follow-up. One hundred fifty-four patients were enrolled; 50 entered before, and 104 after protocol implementation. Only six (12%) in the preprotocol and one (1%) of the postprotocol group were lost to follow-up. After an OU visit, postprotocol 90-day ED HF revisit rates declined 56% (0.90-0.51; p<0.0000) and the 90-day HF rehospitalization rate decreased 64% (0.77-0.50; p=0.007). The 90-day rates of death and OU HF readmission decreased from 4% to 1% (p=0.096) and 18% to 11% (p=0.099), respectively. An intensive outpatient ED OU HF management protocol safely decreases 90-day rates of emergency department visits and inpatient hospitalizations.