Predictive Factors of 30-day Adverse Events in Acute HeartFailure after Discharge from Emergency Department; aHistorical Cohort Study

The rates of unscheduled emergency department (ED) visits and readmissions after dischargefrom the ED in acute heart failure (AHF) patients are high. This study aimed to identify the predictive factorsof 30-day adverse events after discharge from the ED.

A retrospective study was conducted from 2017to 2019 in patients diagnosed with AHF and discharged from the ED at a tertiary university hospital. Thirty-dayadverse events were defined as (i) unscheduled revisit to the ED with AHF, (ii) hospital admission from AHF, and,(iii) death after discharge from the ED. The predictive factors of 30-day adverse events were examined usingmultivariate analyses by logistic regression.

421 patients with the median age of 73 (IQR: 63-81) yearswere studied (52.3% male). 81 (19.2%) patients had 30-day adverse events. Significant predictive factors of30-day adverse events consisted of underlying valvular heart disease (OR = 2.46; 95%CI: 1.27-4.78; p = 0.008),chronic obstructive pulmonary disease (COPD) (OR = 0.08; 95%CI: 0.01-0.64; p=0.001), malignancy (OR=3.63;95%CI: 1.17-11.24; p = 0.031), New York Heart Association functional class III (OR = 4.88; 95%CI: 0.93-25.59) andIV (OR = 7.23; 95% CI: 1.37-38.08) at the ED (p = 0.035), and serum sodium <135 mmol/L (OR = 2.20; 95%CI: 1.17-4.14; p = 0.014). Precipitating factors were anemia (OR = 2.42; 95%CI: 1.16-5.02; p = 0.021), progressive valvularheart disease (OR = 3.52; 95%CI: 1.35-7.85; p = 0.009), acute kidney injury (OR = 6.98; 95%CI: 2.32-20.96; p <0.001), time to diuretic administration >60 minutes after ED arrival (OR = 3.89; 95%CI: 2.16-7.00; p < 0.001), andno discharge advice for follow-up (OR = 2.30; 95%CI: 1.10-4.77; p = 0.028).

AHF patients who hadgood response to intravenous diuretics and were discharged from the ED were at high risk for 30-day adverseevents. Ten factors predicted 30-day adverse events after discharge from the ED.