Worsening Emergency Department Heart Rate Trajectory and Clinically Significant 7-Day Bouncebacks

Discharge vital signs are used in emergency department (ED) risk assessment, but the association between heart rate (HR) trajectory and adverse outcomes after ED discharge remains unclear.

To evaluate whether an increase in heart rate from triage to discharge is associated with clinically significant 7-day bounceback among discharged adult ED patients.

We conducted a retrospective cohort study of adults discharged from a tertiary academic ED between February 1 and April 30, 2025. The primary predictor was HR increase ≥10 bpm from triage to discharge. The primary outcome was clinically significant 7-day bounceback, defined as a related return visit resulting in admission, observation, transfer, or death. Multivariable logistic regression adjusted for age, sex, comorbidities, and triage acuity.

The cohort included 6635 encounters. Any 7-day ED returns occurred at similar rates among patients with and without HR increase ≥10 bpm, 44 of 415 (10.6%) vs. 664 of 6220 (10.7%), respectively. In contrast, clinically significant bouncebacks occurred in 7 of 415 with HR increase ≥10 bpm (1.7%) compared with 30 of 6220 without it (0.5%). HR increase ≥10 bpm was associated with clinically significant bouncebacks after adjustment, aOR 3.10, 95%CI 1.35-7.13, p = 0.008. Discharge tachycardia alone was not associated with clinically significant bouncebacks, aOR 1.08, 95% CI 0.26-4.51, p = 0.921.

Among discharged adult ED patients, HR increase ≥10 bpm was associated with clinically significant 7-day bounceback but not with any all-cause 7-day ED return. Heart rate trajectory may serve as an additional prompt for reassessment before ED discharge.