Observation Units For Heart Failure Could Reduce
Unnecessary Hospitalizations
Forbes. Pharma & Healthcare 1/09/2013 @ 1:15PM - By Larry Husten, Contributor
"Two new papers published in the Journal of the American College of Cardiology propose that most heart failure (HF) patients who present to the emergency department (ED) don’t need to be hospitalized and can be safely managed in an observation unit. Currently, the vast majority of HF patients who show up in the ED are hospitalized.
In the first paper, Sean Collins and colleagues note that although HF patients have high event rates after hospital discharge, “it is not clear that hospitalization per se is the answer to decreasing these post-discharge event rates.” Most HF patients admitted to the hospital only suffer from congestion and don’t require complex therapies. A basic physical exam and diagnostic tests can identify most high-risk patients, who constitute only about 20% of all HF patients in the ED. Low risk patients can be discharged after a short observation period. Intermediate-risk patients can receive continued treatment and observation but avoid a conventional, and expensive, hospitalization.
The authors propose a national program to disseminate successful protocols and local programs to encourage collaboration among emergency physicians, cardiologists, hospitalists, and primary care physicians. Observational units, they argue, should now be tested in a large randomized clinical trial.
In the second paper, Ashkay Desai and Lynne Stevenson agree that “the need for alternate routes to steer around heart failure hospitalization is indisputable, as is the need to embark on them without delay.” But, they contend, “there are daunting challenges to the immediate implementation of a randomized clinical trial.” They point out that there has been no validation on patient selection or test parameters which would be required for such a trial. “The emergence of a single, uniformly effective strategy is not likely,” they write.
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FIRST PAPER
Is Hospital Admission for Heart Failure Really Necessary?:
The Role of the Emergency Department and Observation Unit in Preventing Hospitalization and Rehospitalization
Collins S et al. J Am Coll Cardiol. 2013;61(2):121-126. doi:10.1016/j.jacc.2012.08.1022
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SECOND PAPER
There Must Be a Better Way: Piloting Alternate Routes Around Heart Failure Hospitalizations
Desay A. & Stevenson L. J Am Coll Cardiol. 2013;61(2):127-130. doi:10.1016/j.jacc.2012.10.015