ED patients with heart failure: identification of an observational unit–appropriate cohort

Objective To identify factors that define a low-risk cohort of patients with acute decompensated heart failure who are suitable for management in an observation unit. Methods Prospective convenience sample of 538 patients who presented to an ED with a diagnosis of congestive heart failure. Observation unit appropriate was defined as a length of stay less than 24 hours and no adverse events (myocardial infarction, death, arrhythmia, or rehospitalization) during the 30-day follow-up period. Results Study criteria were met by 499 patients (mean age, 61 ± 15 years), and 234 (47%) were women. Of these, 133 (27%) met the criteria for observation unit appropriateness. Independent predictors were systolic blood pressure of greater than 160 (odds ratio, 1.8; 95% confidence interval, 1.15-2.7) and normal troponin I (odds ratio, 14.7; 95% confidence interval, 1.9-105). Conclusion Initial blood pressure and troponin I can help identify patients with congestive heart failure at low risk for prolonged hospitalization and adverse events and who are reasonable candidates for observation unit management.