• Anna Mollar, Miguel Lorenzo, Amparo Villaescusa, Raquel Heredia, Gema Miñana, Enrique Santas, Rafael de la Espriella, Clara Sastre, Jose Civera, Ana Martínez, Adriana Conesa, Juan Sanchis, Eduardo Núñez, Antoni Bayés-Genís, and Julio Núñez.
• Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
• Med Clin (Barc). 2022 Aug 26; 159 (4): 157-163.

Introduction And ObjectivesPatients with worsening heart failure (WHF) are frequently hospitalized. However, some of the patients with WHF are discharged from the emergency department without hospitalization. The factors influencing the decision of admission are heterogeneous and, in most cases, remain not well-defined. This study aimed to analyze whether left ventricular ejection fraction (LVEF) influences admission decisions following a visit to the emergency department for WHF.Patients And MethodsThis is a retrospective analysis of 3168 patients discharged from a hospitalization for acute heart failure in a single-center in Spain. During follow-up, visits to the emergency department for WHF, including those hospitalized (WHF-readmissions) and episodes of WHF directly discharged without hospitalization in 24h (WHF-DDWH), were recorded. The association between the LVEF categories (<50% and ≥50%) and recurrent WHF-DDWH was evaluated by negative binomial regression. Estimates of risk were expressed as incidence rate ratios (IRR).ResultsThe mean age (SD) of the study sample was 73.5 (11.2) years, and 1658 (52.3%) showed LVEF>50%. At a median (percentile 25% to percentile 75%) follow-up of 2.7 (1.0-5.8) years, 3341 episodes of WHF in 1439 patients were recorded. Of them, we registered 743 episodes of WHF-DDWH in 468 patients (22.2%). Compared to patients with LVEF<50%, those with LVEF≥50% exhibited an adjusted increased risk of recurrent WHF-DDWH (IRR: 1.36, CI 95%: 1.13-1.62, p=0.001).ConclusionsFollowing an acute heart failure admission, patients with LVEF≥50% showed an increased risk of same-day discharge for WHF.Copyright © 2021 Elsevier España, S.L.U. All rights reserved.

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