ED patients with heart failure: identification of an observational unit-appropriate cohort

Objective: To identify factors that define a low-risk cohort of patients with acute decompensated heart failure who are suitable for management in an observation unit. Methods: Prospective convenience sample of 538 patients who presented to an ED with a diagnosis of congestive heart failure. Observation unit appropriate was defined as a length of stay less than 24 hours and no adverse events (myocardial infarction, death, arrhythmia, or rehospitalization) during the 30-day follow-up period. Results: Study criteria were met by 499 patients (mean age, 61 ± 15 years), and 234 (47%) were women. Of these, 133 (27%) met the criteria for observation unit appropriateness. Independent predictors were systolic blood pressure of greater than 160 (odds ratio, 1.8; 95% confidence interval, 1.15-2.7) and normal troponin I (odds ratio, 14.7; 95% confidence interval, 1.9-105). Conclusion: Initial blood pressure and troponin I can help identify patients with congestive heart failure at low risk for prolonged hospitalization and adverse events and who are reasonable candidates for observation unit management.