Background: Congestive heart failure (CHF) is a common diagnosis with an 80% nationwide admission rate, much greater than the 13% admission rate for all comers. However, reports estimate up to 50% CHF patients were candidates for ED discharge or observation unit management. We developed an educational initiative in collaboration with an integrated outpatient cardiology follow-up program and modeled after the European coLlaboration on Acute decompeNsated Heart Failure (ELAN-HF) score, hypothesizing that we could decrease our overall CHF admission rate.
Methods: The intervention included flyers and monthly emails to ED physicians in the period two months prior to and during the intervention period (1/1/18-6/30/18), which included how to identify potential low-risk CHF patients and how to secure next day cardiology follow-up. The primary outcome was the admission rate for the diagnosis of CHF (ICD-10 I50.9) at our mid-Atlantic academic tertiary care ED with 89k visits per year. Our secondary outcomes were the number of patients with cardiology follow-up and the 30 day return visits for discharged patients. Comparison was made to a pre-intervention time period (1/1/17-6/30/17) using Fisher exact testing.
Results: Following the educational initiative, there was no significant difference in the ED admission rate for patients with a diagnosis of CHF (83.3% pre vs. 93.3% post, p=0.15). We did find a 200% increase in the number of urgent cardiology appointments (n=14 pre, n=28 post). There was no significant difference in 30 day returns for discharged CHF patients (30% pre vs. 20% post, p=0.29).
Conclusion: An ED initiative to educate clinicians on low-risk features of CHF and promotion of an expedited pathway for cardiology follow up did not change the overall admission rate for CHF patients, but it did markedly increase the number of discharged patients able to obtain prompt cardiology follow-up, without increasing the rate of 30 day unscheduled return visits.