Abstract 3144: Early Deaths in Heart Failure Patients Discharged From the Emergency Department: A Population-based Analysis
Background. Although approximately one-third of HF patients visiting the ED are discharged home, little is known about their emergent care and outcomes.
Objectives. To examine the characteristics and outcomes of HF patients discharged from the ED, compared to those admitted to hospital.
Methods. We used the National Ambulatory Care Reporting System and the Canadian Institute of Health Information databases to examine the characteristics and outcomes of patients visiting an ED for HF in Ontario, Canada (Apr 2004-Mar 2007). We examined factors associated with hospital admission, and the observed and predicted mortality among those discharged or admitted.
Results. Of 50,816 patients (76±12 yrs, 49% men) visiting an ED for HF, 16,094 (32%) were discharged without hospital admission. Among patients who were discharged from the ED without hospital admission, 4.0% died within 30 days and 1.3% died within one week of discharge. Prior HF was a predictor of increased mortality risk among those discharged from hospital. With increasing number of prior HF hospitalizations (0, 1, or ≥2), the 30-day mortality rates increased: 3.8%, 4.7%, and 7.5%, respectively. The number of noncardiac comorbidities in those discharged also increased death risk with 30-day mortality rates of 3.1%, 5.6%, and 8.9% for those with 0, 1, and ≥2 conditions present. Despite the above, prior HF and presence of comorbidities did not increase the likelihood of hospital admission. Patients were more likely to be admitted if they were older (odds ratio 1.08, 95%CI; 1.06 –1.10 per decade), they arrived by ambulance (odds ratio 2.02, 95%CI; 1.93–2.12), had higher triage acuity score (odds ratio 4.12, 95%CI; 3.84 – 4.42), or received resuscitation in the emergency department (odds ratio 2.85, 95%CI; 2.68 –3.04). Among HF patients with comparable predicted risks of death at 7 days, subsequent 90-day mortality rates were higher among discharged than admitted patients (12.4% vs. 9.4%; p<0.001). Similarly in those with comparable predicted risks of death at 30 days, subsequent 90-day mortality rates were again higher among discharged patients (11.9% vs. 9.5%; p=0.016).
Conclusions. HF patients who are discharged from the ED have substantial risks of early death which may exceed that of hospitalized patients.