© 2008 European Society of Cardiology
Acute heart failure in the emergency department: Short and long-term outcomes of elderly patients with heart failure
a Division of Cardiology, Department of Medicine University of Alberta Canada
b Canadian VIGOUR Center Canada
* Corresponding author. 2C2 Cardiology, University of Alberta, 8440-112 street, Edmonton, Alberta, Canada. Tel.: +1 780 407 8719; fax: +1 780 407 6452. E-mail address: justin.ezekowitz{at}ualberta.ca (J.A. Ezekowitz).
 |
Abstract |
|---|
Aims: Previous epidemiologic studies of acute heart failure (AHF) have involved patients admitted to hospital and fail to account for that unknown proportion discharged directly from the emergency department (ED). We examined discharge rates, and whether outcomes, including mortality, differed based on admission status in AHF.
Methods and results: This population-based cohort included all patients 
65 years presenting to an Alberta ED with HF (ICD9-CM 428.x; 1998 to 2001). Patients were either not admitted (Not-ADM) or directly admitted to hospital (ADM) and followed for one-year.
Of 10,415 AHF patients evaluated in the ED, 35% were Not-ADM whereas 65% were ADM. Thirty days after ED presentation the rates of death, re-ED or initial/re-hospitalisation were 3.3%, 44% and 19% for Not-ADM, and 10.9%, 33% and 21% for the ADM patients, respectively (all p<0.0001). At one-year, the rates of death, re-ED or initial/re-hospitalisation were 20%, 82% and 58% for Not-ADM, and 34%, 72% and 60% for ADM, respectively (all p<0.0001).
Conclusions: One third of AHF patients were not immediately admitted after an ED visit but most present again to the ED, two-thirds were hospitalised and 20% died within the first year. Our findings provide new impetus to undertake risk assessment and treatment strategies in the ED for AHF.
Key Words: Heart failure • Epidemiology • Survival
Received August 4, 2007; Revised November 30, 2007; Accepted January 24, 2008
1 Justin A.Ezekowitz and Padma Kaul are supported by the Canadian Institute of Health Research.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. A. Ezekowitz, P. Kaul, J. A. Bakal, P. W. Armstrong, R. C. Welsh, and F. A. McAlister Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction. J. Am. Coll. Cardiol., January 6, 2009; 53(1): 13 - 20. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. van Diepen, S. R. Majumdar, J. A. Bakal, F. A. McAlister, and J. A. Ezekowitz Heart Failure Is a Risk Factor for Orthopedic Fracture: A Population-Based Analysis of 16 294 Patients Circulation, November 4, 2008; 118(19): 1946 - 1952. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Nieminen and V.-P. Harjola Heart failure in the elderly: How risky is it to be discharged? Eur J Heart Fail, March 1, 2008; 10(3): 222 - 223. [Full Text] [PDF]
|
|