Early Deaths in Patients With Heart Failure Discharged From the Emergency Department

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Abstract
Background— Although approximately one third of patients with heart failure (HF) visiting the emergency department (ED) are discharged home, little is known about their care and outcomes. Methods and Results— We examined the acute care and early outcomes of patients with HF who visited an ED and were discharged without hospital admission in Ontario, Canada, from April 2004 to March 2007. Among 50 816 patients (age, 76.4±11.6 years; 49.4% men) visiting an ED for HF, 16 094 (31.7%) were discharged without hospital admission. A total of 4.0% died within 30 days from admission, and 1.3% died within 7 days of discharge from the ED. Although multiple (≥2) previous HF admissions (odds ratio [OR], 1.64; 95% CI, 1.14 to 2.31), valvular heart disease (OR, 1.37; 95% CI, 1.00 to 1.84), peripheral vascular disease (OR, 1.41; 95% CI, 1.00 to 1.93), and respiratory disease (OR, 1.33; 95% CI, 1.08 to 1.63) increased the risk of 30-day death among those discharged from the ED, presence of these conditions did not increase the likelihood of admission. Patients were more likely to be admitted if they were older (OR, 1.08; 95% CI, 1.06 to 1.10 per decade), arrived by ambulance (OR, 2.02; 95% CI, 1.93 to 2.12), had a higher triage acuity score (OR, 4.12; 95% CI, 3.84 to 4.42), or received resuscitation in the ED (OR, 2.85; 95% CI, 2.68 to 3.04). In those with comparable predicted risks of death, subsequent 90-day mortality rates were higher among discharged than admitted patients (11.9% versus 9.5%; log-rank P =0.016). Conclusions— Patients with HF who are discharged from the ED have substantial risks of early death, which, in some cases, may exceed that of hospitalized patients.

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