Patients who were seen within the two week period as recommended by the CCS had fewer adverse events: they were less likely to return to the ED, be hospitalized, or die, although the result was not statistically significant.
However, the tendency to have worse outcomes, which were deemed to be more deaths, more readmissions to hospital for heart failure, or a repeat visit to the emergency department, was significantly greater in patients who were not seen by a physician until four weeks after their visit to the ED. "Patients who do not receive prompt follow up (somewhere between 2 and 4 weeks) after their ED visit are at higher risk of dying, or being readmitted to the ED or to the hospital," Dr. Feldman said.
Dr. Feldman's study also found that by six weeks, 61 per cent of patients had been seen by a physician, and by three months, 95 per cent had been seen.
"It's urgent to ensure that there is appropriate follow up for these patients," says Dr. Blair O'Neill, president of the Canadian Cardiovascular Society. "We need to optimize adherence to these guidelines."
New simple risk score can guide admission vs. discharge decision-making
In another study, Dr. Douglas Lee, cardiologist at the Peter Munk Cardiac Centre and scientist at the Institute for Clinical Evaluative Sciences (ICES), told the meeting that it is only recently that tools have started to become available to allow physicians to make effective decisions based on acute prognosis of heart failure patients who present to the ED.
"Despite over one million visits to the ED in North America every year, we still have very little evidence to help us decide who could be discharged home and who should be admitted to hospital," Dr. Lee said.
Meanwhile, heart failure is on the rise as more people survive heart attacks and other cardiac conditions. People with heart disease are living longer and these are peo
|Contact: Amanda Bates|
Heart and Stroke Foundation of Canada