Dana R Sax1, Dustin G Mark2, Renee Y Hsia2, Thida C Tan2, Grace H Tabada2, Alan S Go2. 1. From the Department of Emergency Medicine, Kaiser Permanente Oakland Medical Center, CA (D.R.S., D.G.M.); Departments of Emergency Medicine and Philip R. Lee Institute for Health Policy Studies (R.Y.H.) and Epidimiology, Biostatistics, and Medicine (A.S.G.), University of California San Francisco; and Kaiser Permanente Northern California Division of Research, Oakland (A.S.G, T.C.T, G.H.T) dana.r.sax@kp.org. 2. From the Department of Emergency Medicine, Kaiser Permanente Oakland Medical Center, CA (D.R.S., D.G.M.); Departments of Emergency Medicine and Philip R. Lee Institute for Health Policy Studies (R.Y.H.) and Epidimiology, Biostatistics, and Medicine (A.S.G.), University of California San Francisco; and Kaiser Permanente Northern California Division of Research, Oakland (A.S.G, T.C.T, G.H.T).
Abstract
BACKGROUND: Although 80% of patients with heart failure seen in the emergency department (ED) are admitted, less is known about short-term outcomes and demand for services among discharged patients. METHODS AND RESULTS: We examined adult members of a large integrated delivery system who visited an ED for acute heart failure and were discharged from January 1, 2013, through September 30, 2014. The primary outcome was a composite of repeat ED visit, hospital admission, or death within 7 days of discharge. We identified multivariable baseline patient-, provider-, and facility-level factors associated with adverse outcomes within 7 days of ED discharge using logistic regression. Among 7614 patients, mean age was 77.2 years, 51.9% were women, and 28.4% were people of color. Within 7 days of discharge, 75% had outpatient follow-up (clinic, telephone, or e-mail), 7.1% had an ED revisit, 4.7% were hospitalized, and 1.2% died. Patients who met the primary outcome were more likely to be older, smokers, have a history of hemorrhagic stroke, hypothyroidism, and dementia, and less likely to be treated in a facility with an observation unit. In multivariable analysis, higher comorbidity scores and history of smoking were associated with a higher odds of the primary outcome, whereas treatment in a facility with an observation unit and presence of outpatient follow-up within 7 days were associated with a lower odds. CONCLUSIONS: We identified selected hospital and patient characteristics associated with short-term adverse outcomes. Further understanding of these factors may optimize safe outpatient management in ED-treated patients with heart failure.
BACKGROUND: Although 80% of patients with heart failure seen in the emergency department (ED) are admitted, less is known about short-term outcomes and demand for services among discharged patients. METHODS AND RESULTS: We examined adult members of a large integrated delivery system who visited an ED for acute heart failure and were discharged from January 1, 2013, through September 30, 2014. The primary outcome was a composite of repeat ED visit, hospital admission, or death within 7 days of discharge. We identified multivariable baseline patient-, provider-, and facility-level factors associated with adverse outcomes within 7 days of ED discharge using logistic regression. Among 7614 patients, mean age was 77.2 years, 51.9% were women, and 28.4% were people of color. Within 7 days of discharge, 75% had outpatient follow-up (clinic, telephone, or e-mail), 7.1% had an ED revisit, 4.7% were hospitalized, and 1.2% died. Patients who met the primary outcome were more likely to be older, smokers, have a history of hemorrhagic stroke, hypothyroidism, and dementia, and less likely to be treated in a facility with an observation unit. In multivariable analysis, higher comorbidity scores and history of smoking were associated with a higher odds of the primary outcome, whereas treatment in a facility with an observation unit and presence of outpatient follow-up within 7 days were associated with a lower odds. CONCLUSIONS: We identified selected hospital and patient characteristics associated with short-term adverse outcomes. Further understanding of these factors may optimize safe outpatient management in ED-treated patients with heart failure.
Authors: Austin S Kilaru; Nicholas Illenberger; Zachary F Meisel; Peter W Groeneveld; Manqing Liu; Angira Mondal; Nandita Mitra; Raina M Merchant Journal: Circ Cardiovasc Qual Outcomes Date: 2022-09-08
Authors: Gregory J Fermann; Jon W Schrock; Phillip D Levy; Peter Pang; Javed Butler; Anna Marie Chang; Douglas Char; Deborah Diercks; Jin H Han; Brian Hiestand; Chris Hogan; Cathy A Jenkins; Christy Kampe; Yosef Khan; Vijaya A Kumar; Sangil Lee; JoAnn Lindenfeld; Dandan Liu; Karen F Miller; W Frank Peacock; Carolyn M Reilly; Chad Robichaux; Russell L Rothman; Wesley H Self; Adam J Singer; Sarah A Sterling; Alan B Storrow; William B Stubblefield; Cheryl Walsh; John Wilburn; Sean P Collins Journal: J Am Coll Emerg Physicians Open Date: 2022-04-09