Evidence map›Paper›PMID 33709357›Full record

ArticleCJEM2021

Interdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department.

Ian G Stiell, Lisa Mielniczuk, Heather D Clark, Guy Hebert, Monica Taljaard, Alan J Forster, George A Wells, Catherine M Clement, Jennifer Brinkhurst, Erica L Brown and 2 more

Abstract read
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In one paragraph

Article in CJEM, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Addressing Frailty in the Emergency Department: Early Outcomes of a Geriatric Rapid Access Clinic.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026
    Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Ian G StiellDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. istiell@ohri.ca.
Lisa MielniczukDivision of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada.
Heather D ClarkDivision of Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Guy HebertDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Monica TaljaardClinical Epidemiology Program, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Alan J ForsterClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
George A WellsClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Catherine M ClementClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Jennifer BrinkhurstClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Erica L BrownClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Marie-Joe NemnomClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Jeffrey J PerryDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionAcute heart failure patients often have an uncertain or delayed follow-up after discharge from the ED. Our goal was to introduce rapid-access specialty clinics to ensure acute heart failure patients were seen within 7 days, in an effort to reduce admissions and improve follow-up care.

methodsThis prospective cohort study was conducted at two campuses of a large tertiary care hospital. We enrolled acute heart failure patients who presented to the ED with shortness of breath and were later discharged. Following a 12-month before period, we introduced rapid-access acute heart failure clinics staffed by cardiology and internal medicine. We allowed for a 3-month implementation period and then observed outcomes over the subsequent 12-month after period. The primary outcome was hospital admission within 30 days. Secondary outcomes included mortality and actual access to specialty care.

resultsPatients in the before (N = 355) and after periods (N = 374) were similar for age and most characteristics. Segmented autoregression analysis demonstrated there was a pre-existing trend to fewer admissions. Attendance at a specialty clinic increased from 17.8 to 42.1% (P < 0.01) and the median days to the clinic decreased from 13 to 6 days (P < 0.01). 30-days mortality did not change.

conclusionImplementation of rapid-access clinics for acute heart failure patients discharged from the ED did not lead to an overall decrease in hospital admissions. It did, however, lead to increased access to specialist care, reduced follow-up times, without an increase in return ED visits or mortality. Widespread use of this rapid-access approach to a specialist can improve care for acute heart failure patients discharged home from the ED.

Indexed as

Emergency Service, HospitalHeart FailureHospitalizationHumansPatient DischargeProspective StudiesEmergency departmentHeart failurePatient safety

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.