期刊
EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
卷 6, 期 4, 页码 311-320出版社
OXFORD UNIV PRESS
DOI: 10.1177/2048872616633853
关键词
Acute heart failure; emergency department; discharge; risk stratification; prognosis
资金
- Instituto de Salud Carlos III
- Spanish Ministry of Health
- FEDER [PI15/01019, PI15/00773, PI11/01021]
- La Marato de TV3
- National Institutes of Health/National Heart, Lung and Blood Institute [1-K23-HL123533-01A1]
- Catalonia Govern for Consolidated Groups of Investigation [GRC 2009/1385, 2014/0313]
Heart failure is a global public health challenge frequently presenting to the emergency department. After initial stabilization and management, one of the most important decisions is to determine which patients can be safely discharged and which require hospitalization. This is a complex decision that depends on numerous subjective factors, including both the severity of the patient's underlying condition and an estimate of the acuity of the presentation. An emergency department observation period may help select the correct option. Ideally, during an observation period, risk stratification should be carried out using parameters specifically designed for use in the emergency department. Unfortunately, there is little objective literature to guide this disposition decision. An objective and reliable definition of low-risk characteristics to identify early discharge candidates is needed. Benchmarking outcomes in patients discharged from the emergency department without hospitalization could aid this process. Biomarker determinations, although undoubtedly useful in establishing diagnosis and predicting longer-term prognosis, require prospective validation for emergency department disposition guidance. The challenge of identifying emergency department acute heart failure discharge candidates will only be overcome by future multidisciplinary research defining the current knowledge gaps and identifying potential solutions.
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