OBJECTIVE: To identify factors that define a low-risk cohort of patients with acute decompensated heart failure who are suitable for management in an observation unit. METHODS: Prospective convenience sample of 538 patients who presented to an ED with a diagnosis of congestive heart failure. Observation unit appropriate was defined as a length of stay less than 24 hours and no adverse events (myocardial infarction, death, arrhythmia, or rehospitalization) during the 30-day follow-up period. RESULTS: Study criteria were met by 499 patients (mean age, 61 +/- 15 years), and 234 (47%) were women. Of these, 133 (27%) met the criteria for observation unit appropriateness. Independent predictors were systolic blood pressure of greater than 160 (odds ratio, 1.8; 95% confidence interval, 1.15-2.7) and normal troponin I (odds ratio, 14.7; 95% confidence interval, 1.9-105). CONCLUSION: Initial blood pressure and troponin I can help identify patients with congestive heart failure at low risk for prolonged hospitalization and adverse events and who are reasonable candidates for observation unit management.
OBJECTIVE: To identify factors that define a low-risk cohort of patients with acute decompensated heart failure who are suitable for management in an observation unit. METHODS: Prospective convenience sample of 538 patients who presented to an ED with a diagnosis of congestive heart failure. Observation unit appropriate was defined as a length of stay less than 24 hours and no adverse events (myocardial infarction, death, arrhythmia, or rehospitalization) during the 30-day follow-up period. RESULTS: Study criteria were met by 499 patients (mean age, 61 +/- 15 years), and 234 (47%) were women. Of these, 133 (27%) met the criteria for observation unit appropriateness. Independent predictors were systolic blood pressure of greater than 160 (odds ratio, 1.8; 95% confidence interval, 1.15-2.7) and normal troponin I (odds ratio, 14.7; 95% confidence interval, 1.9-105). CONCLUSION: Initial blood pressure and troponin I can help identify patients with congestive heart failure at low risk for prolonged hospitalization and adverse events and who are reasonable candidates for observation unit management.
Authors: Sean Collins; Alan B Storrow; Nancy M Albert; Javed Butler; Justin Ezekowitz; G Michael Felker; Gregory J Fermann; Gregg C Fonarow; Michael M Givertz; Brian Hiestand; Judd E Hollander; David E Lanfear; Phillip D Levy; Peter S Pang; W Frank Peacock; Douglas B Sawyer; John R Teerlink; Daniel J Lenihan Journal: J Card Fail Date: 2014-07-18 Impact factor: 5.712
Authors: Sean P Collins; Alan B Storrow; Phillip D Levy; Nancy Albert; Javed Butler; Justin A Ezekowitz; G Michael Felker; Gregory J Fermann; Gregg C Fonarow; Michael M Givertz; Brian Hiestand; Judd E Hollander; David E Lanfear; Peter S Pang; W Frank Peacock; Douglas B Sawyer; John R Teerlink; Daniel J Lenihan Journal: Acad Emerg Med Date: 2014-11-25 Impact factor: 3.451
Authors: Jason M Hockenberry; Ryan Mutter; Marguerite Barrett; Judy Parlato; Michael A Ross Journal: Health Serv Res Date: 2013-12-18 Impact factor: 3.402
Authors: Sean P Collins; Christopher J Lindsell; Cathy A Jenkins; Frank E Harrell; Gregory J Fermann; Karen F Miller; Sue N Roll; Matthew I Sperling; David J Maron; Allen J Naftilan; John A McPherson; Neal L Weintraub; Douglas B Sawyer; Alan B Storrow Journal: Am Heart J Date: 2012-10-29 Impact factor: 4.749