Safety and efficiency of discharge to home hospitalization directly after emergency department care of patients with acute heart failure

Carolina Sánchez Marcos1, Begoña Espinosa2, Emmanuel Coloma3, David San Inocencio2, Sonja Pilarcikova1, Sergio Guzmán Martínez2, Mariona Ramón1, Alejandro Carratalá Ballesta2, Omar Saavedra1, Nicole Ivars Obermeier2, Ernest Bragulat1, Adriana Gil-Rodrigo2, Ainoa Ugarte3, Pere Llorens2, Òscar Miró1

Affiliation of the authors

1Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Spain. 2Emergency, Short Stay and Home Hospitalization Service, Hospital General Dr. Balmís, Alicante, Spain. Dr. Balmís, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain. 3Home Hospitalization Unit, Medical Directorate, Hospital Clínic, Barcelona, Spain.



Sánchez Marcos C, Espinosa B, Coloma E, San Inocencio D, Pilarcikova S, Guzmán Martínez S, et al. Safety and efficiency of discharge to home hospitalization directly after emergency department care of patients with acute heart failure. Emergencias. 2023;35:176-84



To analyze whether discharge to home hospitalization (HHosp) directly from emergency departments (EDs) after care for acute heart failure (AHF) is efficient and if there are short-term differences in outcomes between patients in HHosp vs those admitted to a conventional hospital ward (CHosp).


Secondary analysis of cases from the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments). The EAHFE is a multicenter, multipurpose, analytical, noninterventionist registry of consecutive AHF patients after treatment in EDs. Cases were included retrospectively and registered to facilitate prospective follow-up. Included were all patients diagnosed with AHF and discharged to HHosp from 2 EDs between March 2016 and February 2019 (3 years). Cases from 6 months were analyzed in 3 periods: March-April 2016 (corresponding to EAHFE-5), January-February 2018 (EAHFE-6), and January-February 2019 (EAHFE-7). The findings were adjusted for characteristics at baseline and during the AHF decompensation episode.


A total of 370 patients were discharged to HHosp and 646 to CHosp. Patients in the HHosp group were older and had more comorbidities and worse baseline functional status. However, the decompensation episode was less severe, triggered more often by anemia and less often by a hypertensive crisis or acute coronary syndrome. The HHosp patients were in care longer (median [interquartile range], 9 [7-14] days vs 7 [5-11] days for CHosp patients, P < .001), but there were no differences in mortality during hospital care (7.0% vs. 8.0%, P = .56), 30-day adverse events after discharge from the ED (30.9% vs. 32.9%, P = .31), or 1-year mortality (41.6% vs. 41.4%, P = .84). Risks associated with HHosp care did not differ from those of CHosp. The odds ratios (ORs) for HHosp care were as follows for mortality while in care, OR 0.90 (95% CI, 0.41-1.97); adverse events within 30 days of ED discharge, OR 0.88 (95% CI, 0.62-1.26); and 1-year mortality, OR 1.03 (95% CI, 0.76-1.39). Direct costs of HHosp and CHosp averaged €1309 and €5433, respectively. Conclusion. After ED treatment of AHF, discharge to HHosp requires longer care than CHosp, but short- and long-term outcomes are the same and at a lower cost.


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