You Can't Go Home Again -- Risk Stratification and Acute Heart Failure

Bryan H. Lassner, MD; Andrea S. Kreiger, MD


AccessMedicine from McGraw-Hill 

In This Article


Acute heart failure (AHF) is an extremely common presentation in the Emergency Department (ED). The care of these patients can be challenging as they frequently present with co-morbidities, and there is a lack of strong evidence to help guide patient disposition.[1,2] In addition, patients with AHF have an historically high rate of ED bounce back and hospital readmission. To date, there have been few studies to assist us in determining which AHF patients are "safe for ED discharge", and more than 80% of HF patients are eventually admitted to the hospital.[3,4] Currently, there are no widely used guidelines or decision rules to help identify patients at high risk for death or other significant morbidities.[4,5,6] Current ACEP clinical policy guidelines make no recommendations regarding the need for hospital admission for AHF.[5] Likewise, the 2013 ACC/AHA guidelines make no mention of ED disposition and only recommend that IV diuretics "should begin in the emergency department without delay".[6] We clearly need more validated risk stratification tools for AHF patients. Multiple researchers have tried to develop stratification scales for AHF patients in the hopes of both minimizing adverse events while limiting hospital admissions.[3,4] The results of one recent study published in the Journal of Academic Emergency Medicine attempts to develop a risk scoring system that can be easily implemented in the ED.