Heart Failure Clinical Pathway Reduces ED Admissions


A clinical pathway for coordinating the care of patients with heart failure may reduce admissions to the ED without increasing ED congestion, according to recent research published in The American Journal of Emergency Medicine (online December 7, 2017; doi:10.1016/j.ajem.2017.12.012).

A multidisciplinary team at an academic medical center designed an Acutely Decompensated Heart Failure Clinical Pathways (ADHFCP) program to reduce inpatient readmission rates among those with heart failure. Included in the intervention techniques of the program was an immediate consultation for a cardiologist who was familiar with an ADHFCP patient when the patient presented at the ED.

Travis B Wassermann, MD, University of Chicago Pritzker School of Medicine, and colleagues conducted a study to analyze how the ADHFCP program impacted resource utilization in the ED and its subsequent effect on rates of admission from the ED and on disposition times. Researchers retrospectively risk stratified and matched ADHFCP inpatient visits with non-program inpatient visits (control group).

A Cox survival model was used to assess the ADHFCP’s impact on patients’ likelihood to visit the ED. Wilcoxon’s rank-sum test evaluated the program’s impact on bed-to-disposition time in the ED as well as doses of diuretics administered in the ED.

Results of the study showed that while no impact of the ADHFCP program on patients’ likelihood of visiting the ED was observed, patients in the program presenting to the ED were 13.1 percentage points (95% CI, 3.6-22.6) less likely to be admitted.


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Additionally, Dr Wassermann and colleagues reported no difference in bed-to-disposition times. However, ADHFCP patients received diuretics more frequently and at higher doses than patients in the control group.

“Improved communication between cardiologists and ED physicians through the establishment of an explicit pathway to coordinate the care of heart failure patients may decrease that population’s likelihood of admission without increasing ED disposition times,” authors of the study concluded.—Zachary Bessette