ArticleClinical research in cardiology : official journal of the German Cardiac Society2017
IMPROV-ED study: outcomes after discharge for an episode of acute-decompensated heart failure and comparison between patients discharged from the emergency department and hospital wards.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review.European heart journal. Acute cardiovascular care · 2020Pooled it
- Prognostic Impact of Hospital Discharge After Heart Failure Admission Without Structured Heart Failure Follow-Up.Journal of clinical medicine · 2024Article
- Incidence of Timely Outpatient Follow-Up Care After Emergency Department Encounters for Acute Heart Failure.Circulation. Cardiovascular quality and outcomes · 2022Article
- Recurrent infective endocarditis versus first-time infective endocarditis after heart valve surgery.Clinical research in cardiology : official journal of the German Cardiac Society · 2020Article
- Time-pattern of adverse outcomes after an infection-triggered acute heart failure decompensation and the influence of early antibiotic administration and hospitalisation: results of the PAPRICA-3 study.Clinical research in cardiology : official journal of the German Cardiac Society · 2020Article
- Mode of presentation and mortality amongst patients hospitalized with heart failure? A report from the First Euro Heart Failure Survey.Clinical research in cardiology : official journal of the German Cardiac Society · 2019Article
- Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure.Clinical research in cardiology : official journal of the German Cardiac Society · 2018Observational
- Association of mineralocorticoid receptor antagonist use and in-hospital outcomes in patients with acute heart failure.Clinical research in cardiology : official journal of the German Cardiac Society · 2018Observational
Corrections and comments
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Authors and funding
12 authors at 8 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo define the short- and mid-term outcomes of patients discharged after an episode of acute-decompensated heart failure (ADHF) and evaluate the differences between patients discharged directly from the emergency department (ED) and those discharged after hospitalization.
methodsWe performed a prospective, multicenter, cohort-designed study, including consecutive patients diagnosed with ADHF in 27 Spanish EDs. Thirty-four variables on epidemiology, comorbidity, baseline status, vital signs, signs of congestion, laboratory tests, and treatment were collected in every patient. The primary outcome was a combined endpoint of ED revisit (without hospitalization) or hospitalization due to ADHF, or all-cause death. Secondary outcomes were each of these three events individually. Outcomes were obtained by survival analysis at different timepoints in the entire cohort, and crude and adjusted comparisons were carried out between patients discharged directly from the ED and after hospitalization.
resultsOf the 3233 patients diagnosed with ADHF during a 2-month period, we analyzed 2986 patients discharged alive: 787 (26.4%) discharged from the ED and 2199 (73.6%) after hospitalization. The cumulative percentages of events for the whole cohort (at 7/30/180 days) for the combined endpoint were 7.8/24.7/57.8; for ED revisit 2.5/9.4/25.5; for hospitalization 4.6/15.3/40.7; and for death 0.9/4.3/16.8. After adjustment for patient profile and center, significant increases were found in the hazard ratios for ED- compared to hospital-discharged patients in the combined endpoint, ED revisit and hospitalization, being higher at short-term [at 7 days, 2.373 (1.678-3.355), 2.069 (1.188-3.602), and 3.071 (1.915-4.922), respectively] than at mid-term [at 180 days, 1.368 (1.160-1.614), 1.642 (1.265-2.132), and 1.302 (1.044-1.623), respectively]. No significant differences were found in death.
conclusionsPatients with ADHF discharged from the ED have worse outcomes, especially at short term, than those discharged after hospitalization. The definition and implementation of effective strategies to improve patient selection for direct ED discharge are needed.
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