Short-Stay Units vs Routine Admission From the Emergency Department in Patients With Acute Heart Failure: The SSU-AHF...

Area of Science:

• Cardiology
• Emergency Medicine
• Health Services Research

Background:

• Acute heart failure (AHF) accounts for over 1 million hospitalizations annually in the US.
• Current management often involves lengthy hospital stays, necessitating exploration of efficient alternatives.
• Short-stay units (SSUs) offer a potential alternative for lower-risk AHF patients.

Purpose of the Study:

• To compare the effectiveness and safety of SSU care versus traditional hospitalization for lower-risk AHF patients.
• To evaluate quality of life and days alive and out of hospital (DAOOH) as key outcomes.

Main Methods:

• A multicenter randomized clinical trial assigned low-risk AHF patients to either SSU care (<24 hours) or hospital admission.
• The study enrolled 193 patients, with follow-up at 30 and 90 days.
• Primary outcome initially planned as DAOOH, later shifted to quality of life (Kansas City Cardiomyopathy Questionnaire - KCCQ-12) due to enrollment limitations.

Main Results:

• No significant difference in KCCQ-12 scores between SSU and hospitalization arms at 30 days (51.3 vs 45.8, P=.19).
• SSU patients had significantly more DAOOH at 30 days (median 26.9 vs 25.4 days, P=.02).
• Adverse events were infrequent and comparable between groups.

Conclusions:

• SSU care is a safe and effective alternative to hospitalization for select lower-risk AHF patients.
• The SSU strategy demonstrates potential for reduced healthcare utilization.
• Larger, adequately powered studies are required to definitively establish the benefits of SSU care for AHF.