Abstract 16241: Outcomes of Acute Heart Failure (AHF) in Different Clinical Settings After Emergency Department (ED) Separation: Risk Stratification With the Emergency Heart Failure Mortality Risk Grade (EHMRG)
BACKGROUND: Decisions to admit or discharge patients with HF and choice of hospital care setting have potential impacts on health resource utilization. After ED separation, the impact of the EHMRG risk score in different post-ED settings is unknown.
OBJECTIVES: To examine mortality and prognostic impact of EHMRG in HF patients who were: a) discharged vs. admitted to hospital ward, or b) admitted to ward vs. intensive/coronary care unit (ICU/CCU).
METHODS: HF patients who presented to ED in Ontario, Canada from 1999-2007 were examined via retrospective chart review. The predictive effect of EHMRG was evaluated in discharged, ward, and ICU/CCU patients. Propensity-matched analyses compared mortality between discharged vs. ward, and ward vs. ICU/CCU patients.
RESULTS: Among 10,300 HF patients (median 78 yrs, 49% men, 52% coronary disease, and 50% with ejection fraction ≤40%), 6987 were admitted to hospital (68%). Of those, 5724 were admitted to ward while 1263 were admitted to ICU/CCU. Within post-ED care setting, there was accentuated mortality risk in the ICU/CCU group compared to ward-admitted patients (Table). Mortality risk was increased only in the highest quintile of those discharged (Table). In propensity-matched analyses, there were no differences in 7-day mortality among those discharged from the ED vs. initially admitted to ward overall (relative risk [RR] 0.62, 95%CI; 0.31-1.23) or comparing discharged vs. ward-admitted patients with lower-risk EHMRG score ≤0 (RR 1.00, 95%CI; 0.14-7.09). Similarly, there was no difference in 7-day mortality among those admitted to ICU/CCU vs. ward (RR 1.39, 95%CI; 0.85-2.26) or comparing ICU/CCU-admitted patients with lower EHMRG scores ≤0 (RR 1.04, 95%CI; 0.18-1.89).
CONCLUSIONS: The EHMRG stratified risk independent of clinical setting after ED separation. Among propensity-matched patients, there was no difference in acute mortality risk, suggesting equipoise in decision-making regarding post-ED disposition.
- © 2013 by American Heart Association, Inc.