Acute decompensated heart failure in the emergency department: Identification of early predictors of outcome

Identification of clinical factors that can predict mortality and hospital early readmission in acute decompensated heart failure (ADHF) patients can help emergency department (ED) physician optimize the care-path and resource utilization. We conducted a retrospective observational study of 530 ADHF patients evaluated in the ED of an Italian academic hospital in 2013. Median age was 82 years, females were 55%; 31.1% of patients were discharged directly from the ED (12.5% after short staying in the observation unit), while 68.9% were admitted to a hospital ward (58.3% directly from the ED and 10.6% after a short observation). At 30 days, readmission rate was 17.7% while crude mortality rate was 9.4%; this latter was higher in patients admitted to a hospital ward in comparison to those who were discharged directly from the ED (12.6% vs. 2.4%, P < .001). Thirty-day mortality was significantly related to older age, higher triage priority, lower mean blood pressure (MBP), and lower pulse oxygen saturation (POS). At 180 days, crude mortality rate was 23.2%, higher in admitted patients compared with discharged ones (29.6% vs. 9.1%, P < .001) and was significantly related to older age, higher serum creatinine, and lower MBP and POS. At 12 and 22 months, crude mortality rates resulted 30.4% and 45.1%, respectively. Simple and objective parameters, such as age ≤82 years, MBP > 104 mm Hg, POS > 94%, may guide the ED physician to identify low-risk patients who can be safely discharged directly from the emergency room or after observation unit stay.