On February 22, a paper was published [1] focusing on whether to discharge patients with acute heart failure from the emergency department and see them as outpatients, or to admit them to hospital. Until now there was no guidance on this issue, resulting in a tendency of emergency physicians to act conservatively and admit patients to hospital.

The paper outlines criteria to help clinicians select patients that can be safely discharged from the emergency department. A novel algorithm shows the order of decisions to be made and what to consider at each step.

The importance of long term follow up is emphasised, regardless of whether patients are discharged directly from the emergency department or spend a period in hospital before being sent home. Follow up planning should be done by the emergency team in collaboration with the general practitioner, cardiologist, and others involved in the patient’s long term care.

According to Professor Christian Mueller (chair of the Acute Heart Failure Study Group of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC)), “this guidance hopefully will improve the management of patients with acute heart failure and make some inroads towards giving them a better outlook.”
ESC Press Release 22 February 2016

Reference

1Miró Ò, Peacock FW, McMurray JJ, Bueno H, Christ M, Maisel AS, Cullen L, Cowie MR, Di Somma S, Martín Sánchez FJ, Platz E, Masip J, Zeymer U, Vrints C, Price S, Mebazaa A, Mueller C. European Society of Cardiology – Acute Cardiovascular Care Association position paper on safe discharge of acute heart failure patients from the emergency department. European Heart Journal: Acute Cardiovascular Care. DOI: 10.1177/2048872616633853