Design and rationale of a randomized trial: Using short stay units instead of routine admission to improve patient centered health outcomes for acute heart failure patients (SSU-AHF)

Fish-Trotter, Hannah; Collins, Sean P.; Danagoulian, Shooshan; Hunter, Benton R.; Li, Xiaochun; Levy, Phillip D.; Messina, Frank C.; Pressler, Susan J.; Pang, Peter S.

doi:10.1016/j.cct.2018.08.003

Cited by 12 publications

(15 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5 Several alternatives to hospital admission have been studied and adopted, including the use of observation units, hospital at-home programs, and dedicated care transition clinics. 6,55,56 Improved care navigation and monitoring might, in some cases, allow ED providers and patients to opt for outpatient management rather than hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure

Kilaru

Illenberger

Meisel

et al. 2022

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background: Patients who are discharged from the emergency department (ED) after an encounter for acute heart failure are at high risk for return hospitalization. These patients may benefit from timely outpatient follow-up care to reassess volume status, adjust medications, and reinforce self-care strategies. This study examines the incidence of outpatient follow-up care after ED encounters for acute heart failure and describes patient characteristics associated with obtaining timely follow-up care. Methods: We conducted a retrospective cohort study using an administrative claims database for a large US commercial insurer, from January 1, 2012 to June 30, 2019. Participants included adult patients discharged from the ED with principal diagnosis of acute heart failure. The primary outcome was obtaining an in-person outpatient clinic visit for heart failure within 30 days. We also examined the competing risk of all-cause hospitalization within 30 days and without an intervening outpatient clinic visit. We estimated competing risk regression models to identify patient characteristics associated with obtaining outpatient follow-up and report cause-specific hazard ratios. Results: The cohort included 52 732 patients, with mean age of 73.9 years (95% CI, 73.8–74.0) and 27 395 (52.0% [95% CI, 51.5–52.4]) female patients. Within 30 days of the ED encounter, 12 279 (23.2%) patients attended an outpatient clinic visit for heart failure, with 8382 (15.9%) patients hospitalized before they could obtain an outpatient clinic visit. In the adjusted analysis, patients that were younger, women, reporting non-Hispanic Black race, and had fewer previous clinic visits were less likely to obtain outpatient follow-up care. Conclusions: Few patients obtain timely outpatient follow-up after ED visits for heart failure, although nearly 20% require hospitalization within 30 days. Improved transitions following discharge from the ED may represent an opportunity to improve outcomes for patients with acute heart failure.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure

Kilaru

Illenberger

Meisel

et al. 2022

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…Acute heart failure (AHF) accounts for 1 million emergency department (ED) visits annually 1 and presents significant dilemmas for risk stratification and ED disposition 2 . Over 80% of AHF patients treated in United States EDs are admitted to the hospital, but as many as half may be low enough risk to avoid admission 3–6 . The forthcoming 2022 update to the American College of Emergency Physicians (ACEP) clinical policy on AHF 7 identified three validated clinical decision instruments (CDI) 8–10 that are useful for risk‐stratification: the STRATIFY risk score, 8,11 the Emergency Heart Failure Mortality Risk Grade (EHMRG), 9,12 and the Ottawa Heart Failure Risk Scale (OHFRS) 10,13 .…”

Section: Introductionmentioning

confidence: 99%

“… 2 Over 80% of AHF patients treated in United States EDs are admitted to the hospital, but as many as half may be low enough risk to avoid admission. 3 , 4 , 5 , 6 The forthcoming 2022 update to the American College of Emergency Physicians (ACEP) clinical policy on AHF 7 identified three validated clinical decision instruments (CDI) 8 , 9 , 10 that are useful for risk‐stratification: the STRATIFY risk score, 8 , 11 the Emergency Heart Failure Mortality Risk Grade (EHMRG), 9 , 12 and the Ottawa Heart Failure Risk Scale (OHFRS). 10 , 13 While all three have validation test characteristics that exceed published performance of emergency physician (EP)‐estimated risk 9 and actual disposition decisions, 12 none were deemed sufficient to direct AHF disposition on their own.…”

Section: Introductionmentioning

confidence: 99%

Point‐of‐care echocardiography of the right heart improves acute heart failure risk stratification for low‐risk patients: The REED‐AHF prospective study

Harrison

Favot

Gowland

et al. 2022

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: Validated acute heart failure (AHF) clinical decision instruments (CDI) insufficiently identify low-risk patients meriting consideration of outpatient treatment.While pilot data show that tricuspid annulus plane systolic excursion (TAPSE) is associated with adverse events, no AHF CDI currently incorporates point-of-care echocardiography (POCecho). We evaluated whether TAPSE adds incremental risk stratification value to an existing CDI. Methods:Prospectively enrolled patients at two urban-academic EDs had POCechos obtained before or <1 h after first intravenous diuresis, positive pressure ventilation, and/or nitroglycerin. STEMI and cardiogenic shock were excluded. AHF diagnosis was adjudicated by double-blind expert review. TAPSE, with an a priori cutoff of ≥17 mm, was our primary measure. Secondary measures included eight additional right heart and six left heart POCecho parameters. STRATIFY is a validated CDI predicting 30-day death/cardiopulmonary resuscitation, mechanical cardiac support, intubation, new/ emergent dialysis, and acute myocardial infarction or coronary revascularization in ED AHF patients. Full (STRATIFY + POCecho variable) and reduced (STRATIFY alone) logistic regression models were fit to calculate adjusted odds ratios (aOR), categoryfree net reclassification index (NRI cont ), ΔSensitivity (NRI events ), and ΔSpecificity (NRI nonevents ). Random forest assessed variable importance. To benchmark risk prediction to standard of care, ΔSensitivity and ΔSpecificity were evaluated at risk thresholds more conservative/lower than the actual outcome rate in discharged patients.Results: A total of 84/120 enrolled patients met inclusion and diagnostic adjudication criteria. Nineteen percent experiencing the primary outcome had higher STRATIFY scores compared to those event free (233 vs. 212, p = 0.009

show abstract

“…Among the cardiology patients admitted at SSU, 57% were discharged from SSU and had low average LOS and mortality, which are characteristics expected to typical SSU patients. [8][9][10]21 (35%) and ICU (8%), respectively. This transfer rate to the conventional ward is higher than that reported for alternative SSUs, which has been <10%.…”

Section: Discussionmentioning

confidence: 99%

Impact of emergency short‐stay unit opening on in‐hospital global and cardiology indicators

Cirillo

Freitas

Kitaka

et al. 2021

Evaluation Clinical Practice

View full text Add to dashboard Cite

Rationale, aims and objectives: Emergency short-stay unit (SSU) alleviates emergency department (ED) overcrowding, but may affect in-hospital indicators. Cardiology patients comprise a substantial part of patients admitted at SSU. This study evaluated whether SSU opening differentially modified in-hospital indicators at a whole general hospital and at its cardiology division (CARD). Methods: We retrospectively analysed indicators based on 859 686 ED visits, and 171 547 hospital admissions, including 12 110 CARD admissions, from 2007 to 2018 at a general tertiary hospital, and compared global ED indicators and in-hospital indicators at the hospital and CARD before (2007-2011) and after (2011-2018) SSU opening. Results: After SSU opening, monthly ED bed occupancy rate decreased (mean ± SD 200 ± 18% vs 187 ± 22%; P < .001) and in-hospital admissions from ED increased at the hospital (median [interquartile range] 460 [81] vs 524 [41], P < .001) and CARD (50 [12] vs 54 [12], P = .004). In parallel, monthly in-hospital elective admissions decreased at CARD (34 [18] vs 28 [17], P = .019), but not at the hospital (712 [73] vs 700 [104], P = .54). Average length of stay (LOS) increased at both hospital (8.5 ± 0.3 vs 8.7 ± 0.4 days, P < .001) and CARD (9.2 ± 1.5 vs 10.3 ± 2.3 days, P = .002) after SSU opening, but percent admissions at SSU showed a direct relationship with LOS solely at CARD. Furthermore, cardiology patients admitted at SSU had greater LOS, prevalence of coronary heart disease and age than those admitted at the conventional cardiology ward.Conclusions: SSU opening improved ED crowding, but was associated with changes in in-hospital indicators, particularly at CARD, and in the characteristics of hospitalized cardiology patients. These findings suggest that in-hospital cardiology services may need re-evaluation following SSU opening at a general hospital.

show abstract

Design and rationale of a randomized trial: Using short stay units instead of routine admission to improve patient centered health outcomes for acute heart failure patients (SSU-AHF)

Cited by 12 publications

References 30 publications

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure

Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure

Point‐of‐care echocardiography of the right heart improves acute heart failure risk stratification for low‐risk patients: The REED‐AHF prospective study

Impact of emergency short‐stay unit opening on in‐hospital global and cardiology indicators

Contact Info

Product

Resources

About