ACUTE Heart Failure Risk Stratification

Over 80% of all emergency department (ED) visits result in discharge. Conversely, over 80% of ED patients with AHF are admitted to the hospital. Disappointingly, this practice persists despite 20 years of effort, with little reason to believe it will change.1 While some patients clearly benefit from hospitalization, up to 50% of ED patients with AHF may be discharged or placed in observation.2, 3 Importantly, nearly half of all patients hospitalized with AHF present with lower risk features, such as a blood pressure > 140mmHg and a BNP < 1000 pg/mL, supporting the idea of a lower risk cohort embedded within the overall AHF population.4 However, this cohort has many associated comorbidities. More importantly, a significant proportion is likely to experience an adverse event at rates perceived by most emergency physicians as too high for ED discharge.5