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.
