Analysis of standards of quality for outcomes in acute heart failure patients directly discharged home from emergency departments and their relationship with the emergency department direct discharge rate

ObjectiveExperts recommended that direct discharge without hospitalization (DDWH) for emergency departments (EDs) able to observe acute heart failure (AHF) patients should be >40%, and these discharged fulfil the following outcome standards: 30-day all-cause mortality <2% (outcome A); 7-day ED revisit due AHF < 10% B); revisit/hospitalization 20% C). We investigated outcomes in a nationwide cohort their relationship with DDWH percentage.MethodsWe analyzed EAHFE registry (includes about 15% of Spanish EDs), calculated percentage each ED, A/B/C patients, overall individual ED. Relationship between was assessed by linear quadratic regression models, non-weighted weighted provided ED.ResultsAmong 17,420 4488 had (25.8%, median stay = 0 days, IQR 0–1). Only 12.9% EDs achieved > 40%. Considering altogether, A/C were above standards (4.3%/29.4%), while B nearly met (B 10.1%). When analyzing EDs, 58.1% them standard, barely (19.3%/9.7%). observed clinically relevant linear/quadratic relationships higher worse (weighted R2 0.184/0.322) C 0.430/0.624), but not A 0.002/0.022).ConclusionsThe this do DDWH. High rates negatively impact or mortality. This may represent an opportunity improvement better selecting early ensuring follow-up after discharge.