Sean P. Collins|Alan B. Storrow
Moving Toward Comprehensive Acute Heart Failure Risk Assessment in the Emergency Department
Vanderbilt University|Vanderbilt University
nearly 700000 emergency department ed visits due acute heart failure ahf 2009 visits result hospital admission account largest proportion projected 70 billion spent heart failure care 2030 edbased risk prediction tools ahf rarely impact disposition decision making major factor contributing 80 admission rate ed patients ahf remained unchanged last several years selfcare behaviors symptom monitoring medication taking dietary adherence exercise associated decreased hospital readmissions yet selfcare remains largely unaddressed ed patients ahf thus represents significant lost opportunity improve patient care decrease ed visits hospitalizations furthermore shared decision making encourages collaborative interaction patients caregivers providers drive care path based mutual agreement observation difficult decisions simplify difficult decisions later particular relevance ed given venue many issues hypothesize patients complex heterogeneous ed patients ahf may need objective evaluation physiologic risk well evaluation barriers ideal selfcare along strategies overcome barriers combining physician gestalt physiologic risk prediction instruments evaluation selfcare information exchange patient provider using shared decision making may provide critical inertia necessary discharge patients home brief ed evaluation