Emergency Department Visits Versus Hospital Readmissions Among Patients Hospitalized for Heart Failure |
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| Affiliation: | 1. Department of Medicine, Duke University Medical Center, Durham, North Carolina;2. Duke Clinical Research Institute, Durham, North Carolina;3. Division of Cardiology, Duke University School of Medicine, Durham, NC;4. Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio;5. Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi;1. Advanced Heart Failure Program, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota;2. Paul and Sheila Wellstone Muscular Dystrophy Center, University of Minnesota, Minneapolis, Minnesota;3. The Neuromuscular Cardiomyopathy Clinic, Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota;1. NYU Grossman School of Medicine, Division of Medical Ethics, New York, New York;2. George Washington University, School of Nursing, Center for Health Policy and Media Engagement, Washington, DC;3. George Washington University, Milken Institute School of Public Health, Department of Health Policy and Management, Washington, DC;1. Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas-Houston, Houston, Texas;2. Advanced Heart Failure & Cardiac Transplantation, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina;3. Division of Cardiology, Duke University Hospital/Duke Clinical Research Institute, Durham, North Carolina;4. Division of Cardiology, University of Minnesota, Minneapolis, Minnesota;5. Division of Cardiology, University of California, San Francisco, California;6. Division of Cardiology, Department of Advanced Heart Failure, Mechanical Support, and Transplant, Baylor Heart and Vascular Hospital, Dallas, Texas;7. Department of Medicine, University of California, San Francisco, California;1. Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA;2. Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy;3. Cardiomyopathy Unit, Heart, Lung and Vessels Department, Careggi University Hospital, Florence, Italy;4. Cardiovascular Research Foundation, New York, NY, USA;1. Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Mount Sinai, New York, NY, USA;2. Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA |
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| Abstract: | BackgroundWorsening heart failure (HF) often requires hospitalization but in some cases may be managed in the outpatient or emergency department (ED) settings. The predictors and clinical significance of ED visits without admission vs hospitalization are unclear.MethodsThe ASCEND-HF trial included 2661 US patients hospitalized for HF with reduced or preserved ejection fraction. Clinical characteristics were compared between patients with a subsequent all-cause ED visit (with ED discharge) within 30 days vs all-cause readmission within 30 days. Factors associated with each type of care were assessed in multivariable models. Multivariable models landmarked at 30 days evaluated associations between each type of care and subsequent 150-day mortality.ResultsThrough 30-day follow-up, 193 patients (7%) had ED discharge, 459 (17%) had readmission, and 2009 (76%) had neither urgent visit. Patients with ED discharge vs readmission were similar with respect to age, sex, systolic blood pressure, ejection fraction, and coronary artery disease, whereas ED discharge patients had a modestly lower creatinine (P < .01). Among patients with either event within 30 days, a higher creatinine and prior HF hospitalization were associated with a higher likelihood of readmission, as compared with ED discharge (P < .02). Landmarked at 30 days, rates of death during the subsequent 150 days were 21.0% for patients who were readmitted and 11.4% for patients discharged from the ED. Compared with patients who were readmitted, ED discharge was independently associated with lower 150-day mortality (adjusted hazard ratio 0.58, 95% confidence interval 0.36–0.92, P = .02).ConclusionsIn this cohort of US patients hospitalized for HF, worse renal function and prior HF hospitalization were associated with a higher likelihood of early postdischarge readmission, as compared with ED discharge. Although subsequent mortality was high after discharge from the ED, this risk of mortality was significantly lower than patients who were readmitted to the hospital. |
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