Analysis of How Emergency Physicians' Decisions to Hospitalize or Discharge Patients With Acute Heart Failure Match the Clinical Risk Categories of the MEESSI-AHF Scale

Autor: José María Álvarez Pérez, Carolina Xipell, Susana Sánchez, Víctor Marquina, José Manuel Torres, María García García, Lluís Llauger, Xavier Rossello, Néstor Hernández, Belén Prieto, Carmen Agüera, Enrique Martín Mojarro, Pascual Piñera, Pablo Herrero-Puente, José Andrés Sánchez Nicolás, Javier Jacob, Ana López, Marta Fuentes Gil, Marta Sánchez González, Maria Isabel Alonso, Lisette Travería Bécquer, Pere Llorens, Carolina Sánchez, Lluís Llauger García, Antonio Noval, Irene Cabello, Alfons Aguirre, María Pilar López-Díez, Francisco Javier Martín-Sánchez, Rosa Escoda, Luis Calderón, Joaquín Vázquez Álvarez, Francisco Javier Lucas-Imbernón, Maria Àngels Pedragosa, Benjamín Brouzet, Rodolfo Romero, Miguel Alberto Rizzi, Beatriz Sierra, Stuart J. Pocock, Patricia Javaloyes, Eva Salvo, Amparo Valero, Inmaculada Jiménez, Héctor Alonso, Aitor Alquezar, Héctor Bueno, Víctor Gil, Carmen Agüera Urbano, Juan Antonio Andueza, Sira Aguiló, Guillermo Llopis García, Òscar Miró, Enrique M. Mojarro, Alex Roset, Esther Rodríguez Adrada, Raquel Torres-Gárate, Francisco Ruiz, Ester Soy Ferrer, Ana Belén Mecina, Josep Mª. Gaytan, José Miguel Franco, Roberto Calvache, Beatriz Amores Arriaga, Sergio Herrera, María Teresa Lorca
Rok vydání: 2018
Předmět:
Zdroj: Annals of emergency medicine. 74(2)
ISSN: 1097-6760
Popis: Study objective The Multiple Estimation of Risk Based on the Emergency Department Spanish Score in Patients With Acute Heart Failure (MEESSI-AHF) is a validated clinical decision tool that characterizes risk of mortality in emergency department (ED) acute heart failure patients. The objective of this study is to compare the distribution of risk categories between hospitalized and discharged ED patients with acute heart failure. Methods We included consecutive acute heart failure patients from 34 Spanish EDs. Patients were retrospectively classified according to MEESSI-AHF risk categories. We calculated the odds of hospitalization (versus direct discharge from the ED) across MEESSI-AHF risk categories. Next, we assessed the following 30-day postdischarge outcomes: ED revisit, hospitalization, death, and their combination. We used Cox hazards models to determine the adjusted association between ED disposition decision and the outcomes among patients who were stratified into low- and increased-risk categories. Results We included 7,930 patients (80.5 years [SD 10.1 years]; women 54.7%; hospitalized 75.3%). Compared with that for low-risk MEESSI-AHF patients, odds ratios for hospitalization of patients in intermediate-, high-, and very-high-risk categories were 1.83 (95% confidence interval [CI] 1.64 to 2.05), 3.05 (95% CI 2.48 to 3.76), and 3.98 (95% CI 3.13 to 5.05), respectively. However, almost half (47.6%) of all discharged patients were categorized as being at increased risk by MEESSI-AHF, and 19.0% of all the increased-risk patients were discharged from the ED. Among the low-risk MEESSI-AHF patients, the 30-day postdischarge mortality did not differ by ED disposition (hazard ratio [HR] for discharged patients with respect to hospitalized ones 0.65; 95% CI 0.70 to 1.11), nor did it differ in the increased-risk group (HR 0.88; 95% CI 0.63 to 1.23). The discharged low-risk MEESSI-AHF patients had higher risks of 30-day ED revisit and hospitalization (HR 1.86, 95% CI 1.57 to 2.20; and HR 1.92, 95% CI 1.54 to 2.40, respectively) compared with the admitted patients, as did the discharged patients in the increased-risk group (HR 1.62, 95% CI 1.39 to 1.89; and HR 1.40, 95% CI 1.16 to 1.68, respectively), with similar results for the combined endpoint. Conclusion The disposition decisions made in current clinical practice for ED acute heart failure patients calibrate with MEESSI-AHF risk categories, but nearly half of the patients currently discharged from the ED fall into increased-risk MEESSI-AHF categories.
Databáze: OpenAIRE
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