Wednesday, March 8, 2017

Disposition of patients with AHF

Resultado de imagen de european journal emergency medicine
Miró O et al. European Journal of Emergency Medicine 2017; 24(1): 2-12
doi: 10.1097/MEJ.0000000000000411
Worldwide, the ED is the primary point of contact for most patients with AHF. Yet, during the most acute phase of hospital management, practice varies widely. Much of this is because of variance in patients and practice patterns, along with geographic differences in ED and hospital staffing, training and management capabilities. Achieving equipoise in patient care would require practice standardization but, given such heterogeneity, development of universal recommendations, particularly as they relate to disposition, is challenging. Identification of low-risk patients with AHF who are safe for early discharge continues to be a related and important unmet global need that is driven largely by a lack of prospectively developed risk stratification tools. In this review, we propose an algorithmic approach to patient disposition that is based on existing, albeit limited, evidence and expert consensus. We remain cognizant of the need to carry out further prospective studies and, to help drive this, we also propose a set of postdischarge outcomes that can reasonably be attributed to ED care and provide estimates of potentially acceptable event rates. It is our hope that this review will lead to further study of AHF disposition from the ED and promote change in the long-standing approach to AHF patient care."