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Title: Disposition of emergency department patients diagnosed with acute heart failure: An international emergency medicine perspective
Authors: Miró, Oscar 
Levy, Philip D. 
Möckel, Martin 
Pang, Peter S. 
Lambrinou, Ekaterini 
Bueno, Hector 
Hollander, Judd E. 
Harjola, Veli-Pekka 
Diercks, Deborah B. 
Gray, Alasdair J. 
Disomma, Salvatore 
Papa, Ann M. 
Collins, Sean P. 
Major Field of Science: Medical and Health Sciences
Field Category: Clinical Medicine
Keywords: Acute heart failure;Emergency department;Patient discharge;Patient disposition;Risk stratification
Issue Date: 1-Feb-2017
Source: European Journal of Emergency Medicine, 2017, vol. 24, no. 1, pp. 2-12
Volume: 24
Issue: 1
Start page: 2
End page: 12
Journal: European Journal of Emergency Medicine 
Abstract: Many patients with acute heart failure are initially managed in emergency departments (EDs) worldwide. Although some require hospitalization for further management, it is likely that a sizeable proportion could be safely discharged either directly from the ED or after a more extended period of management in an observation-type unit. Identification of low-risk patients who are safe for such an approach to management continues to be a global unmet need. This is driven in part by a lack of clarity on postdischarge outcomes for lower risk patients and a nonexistent consensus on what may be acceptable event rates. The current paper reviews previous studies carried out on patients directly discharged from the ED, suggests a general disposition algorithm and focuses on discharge metrics, which are based on both evidence and expert opinion. In addition, we propose that the following variables be considered for future determination of acceptable event rates: (a) baseline characteristics and risk status of the patient; (b) access to follow-up; (c) ED capability to provide an extended period of observation before discharge; (d) the temporal relationship between the event and ED discharge decision; and (e) the type of event experienced.
ISSN: 1473-5695
DOI: 10.1097/MEJ.0000000000000411
Rights: © Wolters Kluwer Health
Type: Article
Affiliation : University of Barcelona 
Hospital Universitario 12 de Octubre 
Free University of Berlin 
Cyprus University of Technology 
Sapienza University Rome 
University of Helsinki 
The University of Edinburgh 
Thomas Jefferson University 
Einstein Medical Center Montgomery 
Wayne State University 
Indiana University 
University of Texas Southwestern 
Vanderbilt University 
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