What is the clinical evidence from this study?

Study design: Observational. Population: Worsening chronic heart failure (n=786). Primary outcome: Proportion of patients who could be sent home after acute treatment.

March 8, 2012Open Access

Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

Key Result

Presentation to the emergency department for worsening chronic heart failure resulted in hospital admission for the vast majority of patients, with only 2% able to be sent home.

Study Design

Type

Observational (n=786)

Multicenter

Structured PICO

Population

786 patients with a previous diagnosis of chronic heart failure (CHF) presenting to the emergency department with dyspnoea and at least one sign and one symptom of worsening CHF. Mean age 79 years, 46% women, based in Sweden.

Outcome

Proportion of patients requiring hospital admission versus those who could be sent home directly from the emergency department, and the reasons for hospital admission.

The vast majority of patients with worsening chronic heart failure presenting to the emergency department require hospital admission, primarily due to serious comorbidities rather than isolated heart failure exacerbation.

Abstract

BACKGROUND: Chronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors.To characterise patients with CHF who seek an emergency department (ED) because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. METHOD: Patients (n = 2,648) seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. RESULTS: Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. CONCLUSION: The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

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