Summary

Factors associated with the need for care escalation in patients with acute heart failure referred from the emergency department to home hospitalization

Carolina Sánchez Marcos¹, Begoña Espinosa², Emmanuel Coloma³, David Nicolás³, David San Inocencio², Víctor Gil¹, Pere Llorens², Òscar Miró¹

Affiliation of the authors

¹Servicio de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. ²Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital Doctor Balmis, ISABIAL, Universidad Miguel Hernández, Alicante, Spain. ³Unidad de Hospitalización a Domicilio, Dirección Médica, Hospital Clínic, Barcelona, Spain.

DOI

Download Article

Quote

Sánchez Marcos C, Espinosa B, Coloma E, Nicolás D, San Inocencio D, Gil V, et al. Factors associated with the need for care escalation in patients with acute heart failure referred from the emergency department to home hospitalization. Emergencias. 2025;37:411-9

Summary

Introduction. Home hospitalization (HH) directly from the emergency department (ED) in patients requiring admission is, overall, a safe and effective alternative. However, in some cases, HH requires escalation of care, and the patient must be transferred to the hospital to complete treatment under conventional inpatient care. This study analyzes the factors associated with the need for such escalation in patients with acute heart failure (AHF).

Method.

Two hospitals reviewed patients with AHF admitted to HH over a 3-year period. Escalation of care was defined as transfer from HH to the hospital to complete inpatient treatment, regardless of cause. The association between escalation need and 24 baseline variables as well as 24 variables from the decompensation episode was evaluated, both crudely and in adjusted analyses. Variables significant in both models were included in a final global multivariable model.

Results.

A total of 367 patients admitted to HH from the ED for AHF were analyzed (median age, 86 years; 53% women). Escalation of care occurred in 52 cases (14%). The only baseline variable independently and inversely associated with the need for escalation was admission to an HH unit where joint evaluation between HH and emergency professionals was conducted to assess HH eligibility. Among the decompensation episode variables, hyponatremia and creatinine > 1.3 mg/dL were directly associated with escalation. These three variables remained significant in the final global model, with adjusted ORs of 0.373 (95% CI, 0.193–0.731), 2.634 (95% CI, 1.196–5.798), and 3.507 (95% CI, 1.80–6.835), respectively.

Conclusions.

The need for escalation in patients with AHF admitted to HH directly from the ED occurs in a moderate percentage of cases and is associated with renal impairment and hyponatremia at admission. Joint participation of HH and emergency professionals in the decision-making process for HH admission reduces the risk of treatment failure in these patients.