Short-stay units may be viable alternatives for admission for acute heart failure

1. This multicentre, randomized, comparative effectiveness study found that the short-stay unit (SSU) was often as effective as hospitalization in patients with new onset of acute heart failure (AHF) and otherwise low-risk profiles. 

2. There was no difference in 30- and 90-day mortality between the SSU and hospitalized patients. 

Evidence Rating Level: 1 (Excellent)

Patients in acute heart failure (AHF) account for a great deal of healthcare spending, particularly due to hospitalizations that often originate from emergency department (ED) visits. Hospitalizations are also not entirely benign with the possibility for in-hospital adverse events and data to suggest a multi-fold increase in 1-year all-cause mortality in patients who are hospitalized for heart failure compared to non-hospitalized counterparts. A model for brief observation (also coined short-stay units [SSU]) is supported in some literature, particularly in AHF patients with otherwise favourable risk profiles. The current study is the first randomized trial to evaluate the efficacy of SSUs for AHF compared to hospitalization. A total of 193 patients across 12 sites (mean [SD] age, 64.8 [14.8] years) were randomized to either the SSU arm (n = 93) or the hospitalization arm (n = 100). There were no differences in the proportions of patients in either arm receiving furosemide treatment, nor were there differences in initial ED therapies received by either arm. At discharge and at 30 days, scores on a questionnaire assessing quality of life in cardiac patients did not differ significantly between the groups (ps = .47 and .19, respectively). While a proportion of patients in the SSU arm required hospitalization, over 60% were sufficiently treated in the SSU environment. SSU patients had 1.6 more days alive and out of hospital (DAOOH) at 30 day follow-up than hospitalized counterparts (p = .02). The total number of deaths at 90 days was comparable at 3 for the SSU arm and 4 for the hospitalization arm. While patients randomized to the SSU arm had slightly lower left ventricular ejection fractions (LVEF) on assessment, this did not appear to impact end-results of the study. This study should be replicated due to limitations in enrollment caused by the COVID-19 pandemic to ascertain the true statistical power of the results. However, the results do indicate that SSUs could be a reasonable alternative to hospitalization for lower-risk patients presenting with symptoms consistent with AHF. 

Click to read the study in JAMA Network Open

Image: PD

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