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A new study by Indiana University School of Medicine researchers found that lower-risk acute heart failure patients have more days alive and out of hospital within 30 days when they are placed in an observation unit, or a short-stay unit, instead of being hospitalized.

Rethinking care pathways: Improved outcomes for acute heart failure patients

Dr. Peter Pang stands in the emergency department.

A new study by Indiana University School of Medicine researchers found that lower-risk acute heart failure patients have more days alive and out of hospital within 30 days when they are placed in an observation unit, or a short-stay unit, instead of being hospitalized. Their findings were recently published in JAMA Network Open.  

Nearly 80% of patients with acute heart failure who present to the emergency department are hospitalized. And with more than a million acute heart failure hospitalizations annually in the United States, there is a pressing need for safe and efficient alternatives.   

“There has been a notable absence of randomized clinical trial data assessing the effectiveness of short-stay unit care for people with acute heart failure, which affects about 3 million adults in the United States,” said Peter S. Pang, MD, chair of the IU School of Medicine Department of Emergency Medicine, who led the study. “Our study showed a positive signal: improvement in 30-day days alive and out of hospital (DAOOH) in the short-stay unit arm. If replicated in a larger study, this could significantly change how we treat acute heart failure.”   

The researchers conducted a multicenter, randomized clinical trial between December 2017 and July 2021 to compare the effectiveness of short-stay unit care versus hospitalization in lower-risk acute heart failure patients. The study involved randomly assigning low-risk acute heart failure patients to either short-stay unit care or hospital admission. Participants were followed up at both 30 and 90 days post-discharge to assess quality of life as the primary outcome and 30-day DAOOH as the secondary outcome.  

The researchers discovered that at the 30-day mark, quality of life was similar between the two groups. However, patients in the short-stay unit had almost two days longer either alive or out-of-the-hospital compared to those who were hospitalized. Notably, adverse events were infrequent and comparable between the two groups, suggesting that the short-stay unit is safe for lower-risk acute heart failure patients.  

Because there was lower than targeted enrollment in the study due to the COVID-19 pandemic, some caution is warranted: further research with a larger sample of patients to definitively ascertain the potential benefits of short-stay unit strategies in acute heart failure care are needed. If confirmed, short-stay units could represent a valuable alternative in managing acute heart failure, potentially reducing health care utilization, and improving patient outcomes.  

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Department of Emergency Medicine

The Department of Emergency Medicine delivers patient care of unsurpassed quality and advanced emergency medicine through education, innovation and discovery in a collegial environment that promotes intellectual and professional growth.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.