Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias · 2025
Factors associated with the need for care escalation in patients with acute heart failure referred from the emergency department to home hospitalization.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Sánchez Marcos Carolina, Espinosa Begoña, Coloma Emmanuel, Nicolás David, San Inocencio David, Gil Víctor, Llorens Pere, Miró Òscar
Аннотация
OBJECTIVE: 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).
METHODS: 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.
METHODS: 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.