{"id":34043,"date":"2013-01-09T13:46:22","date_gmt":"2013-01-09T18:46:22","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=34043"},"modified":"2013-01-09T13:46:22","modified_gmt":"2013-01-09T18:46:22","slug":"observation-units-for-heart-failure-could-reduce-unnecessary-hospitalizations","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/01\/09\/observation-units-for-heart-failure-could-reduce-unnecessary-hospitalizations\/","title":{"rendered":"Observation Units for Heart Failure Could Reduce Unnecessary Hospitalizations"},"content":{"rendered":"<p>Two new papers published in the\u00a0<em>Journal of the American College of Cardiology<\/em>\u00a0propose that most heart failure (HF) patients who present to the emergency department (ED) don&#8217;t need to be hospitalized and can be safely managed in an observation unit. Currently, the vast majority of HF patients \u00a0who show up in the ED are hospitalized.<\/p>\n<p>In\u00a0<a href=\"http:\/\/content.onlinejacc.org\/article.aspx?articleid=1555173\">the first paper<\/a>, Sean Collins and colleagues note that although HF patients have high event rates after hospital discharge, &#8220;it is not clear that hospitalization per se is the answer to decreasing these post-discharge event rates.&#8221; Most HF patients admitted to the hospital suffer only from congestion and don&#8217;t require complex therapies. A basic physical exam and diagnostic tests can identify most high-risk patients, who constitute only about 20% of all HF patients in the ED. Low-risk patients can be discharged after a short observation period. Intermediate-risk patients can receive continued treatment and observation but avoid a conventional, expensive hospitalization.<\/p>\n<p>The authors propose a national program to disseminate successful protocols and local programs to encourage collaboration among\u00a0emergency physicians, cardiologists, hospitalists, and primary care physicians. Observational units, they argue, should now be tested in a large\u00a0randomized clinical trial.<\/p>\n<p>In\u00a0<a href=\"http:\/\/content.onlinejacc.org\/article.aspx?articleid=1555167\">the second paper<\/a>, Ashkay\u00a0Desai and Lynne Stevenson agree that &#8220;the need for alternate routes to steer around heart failure hospitalization is indisputable, as is the need to embark on them without delay.&#8221; But, they contend, &#8220;there are daunting challenges to the immediate implementation of a randomized clinical trial.&#8221; They point out that there has been no validation on the patient selection or test parameters that would be required for such a trial. &#8220;The emergence of a single, uniformly effective strategy is not likely,&#8221; they write.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Two new papers published in the\u00a0Journal of the American College of Cardiology\u00a0propose that most heart failure (HF) patients who present to the emergency department (ED) don&#8217;t need to be hospitalized and can be safely managed in an observation unit. Currently, the vast majority of HF patients \u00a0who show up in the ED are hospitalized. In\u00a0the [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14],"tags":[1620,700,1619],"class_list":["post-34043","post","type-post","status-publish","format-standard","hentry","category-heart-failure","tag-heart-failure-readmissions","tag-hospital-readmissions","tag-observation-units"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/34043","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=34043"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/34043\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=34043"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=34043"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=34043"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}