| Content Provider |
World Health Organization (WHO)-Global Index Medicus |
| Author |
Collins, Sean P. Jenkins, Cathy A. Harrell, Frank E. Liu, Dandan Miller, Karen F. Lindsell, Christopher J. Naftilan, Allen J. McPherson, John A. Maron, David J. Sawyer, Douglas B. Weintraub, Neal L. Fermann, Gregory J. Roll, Susan K. Sperling, Matthew Storrow, Alan B. |
| Spatial Coverage |
United States |
| Description |
Author Affiliation: Collins SP ( Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee); Jenkins CA ( Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.); Harrell FE ( Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.); Liu D ( Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.); Miller KF ( Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.); Lindsell CJ ( Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.); Naftilan AJ ( Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.); McPherson JA ( Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.); Maron DJ ( Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.); Sawyer DB ( Department of Medicine, Division of Cardiovascular Medicine, Maine Medical Center, Portland, Maine.); Weintraub NL ( Department of Medicine and Vascular Biology Center, Georgia Regents University, Augusta, Georgia.); Fermann GJ ( Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.); Roll SK ( Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.); Sperling M ( Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.); Storrow AB ( Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.) |
| Abstract |
OBJECTIVES: No prospectively derived or validated decision tools identify emergency department (ED) patients with acute heart failure (AHF) at low risk for 30-day adverse events who are thus potential candidates for safe ED discharge. This study sought to accomplish that goal. BACKGROUND: The nearly 1 million annual ED visits for AHF are associated with high proportions of admissions and consume significant resources. METHODS: We prospectively enrolled 1,033 patients diagnosed with AHF in the ED from 4 hospitals between July 20, 2007, and February 4, 2011. We used an ordinal outcome hierarchy, defined as the incidence of the most severe adverse event within 30 days of ED evaluation (acute coronary syndrome, coronary revascularization, emergent dialysis, intubation, mechanical cardiac support, cardiopulmonary resuscitation, and death). RESULTS: Of 1,033 patients enrolled, 126 (12%) experienced at least one 30-day adverse event. The decision tool had a C statistic of 0.68 (95% confidence interval: 0.63 to 0.74). Elevated troponin (p < 0.001) and renal function (p = 0.01) were significant predictors of adverse events in our multivariable model, whereas B-type natriuretic peptide (p = 0.09), tachypnea (p = 0.09), and patients undergoing dialysis (p = 0.07) trended toward significance. At risk thresholds of 1%, 3%, and 5%, we found 0%, 1.4%, and 13.0% patients were at low risk, with negative predictive values of 100%, 96%, and 93%, respectively. CONCLUSIONS: The STRATIFY decision tool identifies ED patients with AHF who are at low risk for 30-day adverse events and may be candidates for safe ED discharge. After external testing, and perhaps when used as part of a shared decision-making strategy, it may significantly affect disposition strategies. (Improving Heart Failure Risk Stratification in the ED [STRATIFY]; NCT00508638). |
| File Format |
HTM / HTML |
| ISSN |
22131779 |
| e-ISSN |
22131787 |
| Journal |
JACC: Heart Failure |
| Issue Number |
10 |
| Volume Number |
3 |
| Language |
English |
| Publisher |
Elsevier |
| Publisher Date |
2015-10-01 |
| Publisher Place |
United States |
| Access Restriction |
Open |
| Subject Keyword |
Discipline Cardiology Decision Support Techniques Emergency Service, Hospital Statistics & Numerical Data Heart Failure Therapy Hospital Mortality Patient Readmission Acute Disease Cohort Studies Confidence Intervals Diagnosis Mortality Odds Ratio Patient Admission Predictive Value Of Tests Prospective Studies Risk Assessment Time Factors Comparative Study Observational Study Research Support, N.i.h., Extramural |
| Content Type |
Text |
| Resource Type |
Article |
| Subject |
Cardiology and Cardiovascular Medicine |
