Emergency Short-Stay Unit as an Effective Alternative to In-Hospital Admission for Acute Exacerbation of Chronic Heart Failure

Study Objective: To determine whether a new emergency department short-stay unit (EDSSU) was an effective alternative to conventional hospital units (HU) for acute exacerbation of chronic heart failure patients. Methods: Design: A comparative analysis was used to identify differences among patients admitted to EDSSU (n = 1546) and those admitted to the internal medicine (n = 552) or cardiology wards (n = 336) during the period of the study (January 1, 2008 to December 31, 2012). Setting: The study was performed at Sant Pau Hospital, a 500-bed teaching tertiary care referral center in Barcelona, Spain. The ED attends about 144,000 emergency visits per year. Participants: We studied retrospectively the characteristics of patients hospitalized with an acute exacerbation of chronic heart failure between January 1, 2008 and December 31, 2012 (n = 2434). We chose charts of patients from the hospital discharge database and selected according to the 9th revision of the International Classification of Diseases Codes. We used the computerized database to obtain outcome data on all patients. Results: Statistically significant differences were found in terms of mean age (HU: 77.38 (14.44) years versus EDSSU: 82.43 (8.72) years; p < 0.001), mean length of stay (HU: 11.57 (10.42) days versus EDSSU: 4.75 (3.18) days; p < 0.001), mortality (HU: 14.0% versus EDSSU: 4.0%; p < 0.001), but not for urgent readmission rate of 30 days or less (HU: 18.30% versus EDSSU: 18.30%; p = 0.998). There were statistically significant differences regarding sex (HU women = 60.6%; EDDSU women = 67.7%; p < 0.001) and number of associated conditions (Charlson index HU = 1.25, EDDSU = 0.90; p < 0.001). Conclusion: The EDSSU proved to be an effective and safe measure in emergency care of patients with acute heart failure (AHF).