Skip to main content

Observation Unit Admission Inclusion and Exclusion Criteria

  • Chapter
  • First Online:
Short Stay Management of Acute Heart Failure

Part of the book series: Contemporary Cardiology ((CONCARD))

  • 1081 Accesses

Abstract

Clinical variables readily available to clinicians at the time of presentation are considered in the development of inclusion and exclusion criteria. Initial risk stratification focuses on the prediction of acute inpatient mortality as the primary endpoint and on easily available parameters such as demographics, hemodynamics, comorbidities, and 12-lead electrocardiography (ECG). More recently, biomarkers have been included in risk stratification, specifically cardiac troponin (cTn), high-sensitivity cardiac troponin (hsTn), the natriuretic peptides (NP) B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), and markers of acute kidney injury (AKI). Clinical variables for risk stratification for ADHF are often categorized broadly into demographics, cognitive function/social services, comorbidities, hemodynamics, cardiac ischemia markers, electrolytes, and heart failure biomarkers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ahmed A, et al. Incident heart failure hospitalization and subsequent mortality in chronic heart failure: a propensity-matched study. J Card Fail. 2008;14:211.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rosamond W, et al. Heart disease and stroke statistics–2008 updated: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25.

    Article  PubMed  Google Scholar 

  3. Abraham WT, et al. Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol. 2008;52:347.

    Article  PubMed  Google Scholar 

  4. Fonarow GC, et al. Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA. 2007;297:61.

    Article  PubMed  CAS  Google Scholar 

  5. O’Connor CM, et al. Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J. 2008;156:662.

    Article  PubMed  Google Scholar 

  6. Lee SL, et al. Early deaths in patients with heart failure discharged from the emergency department: a population-based analysis. Circ Heart Fail. 2010;3:228–35.

    Article  PubMed  Google Scholar 

  7. Schrock JW, Emerman CL. Observation unit management of acute decompensated heart failure. Heart Fail Clin. 2009;5(1):85. vii.

    Article  PubMed  Google Scholar 

  8. Collins SP, et al. Cost-effectiveness analysis of ED decision making in patients with non-high-risk heart failure. Am J Emerg Med. 2009;27(3):293.

    Article  PubMed  Google Scholar 

  9. Fine MJ, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. NEJM. 1997;336(4):243.

    Article  PubMed  CAS  Google Scholar 

  10. Selker HP, et al. Use of the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. Ann Intern Med. 1998;129(11):845.

    Article  PubMed  CAS  Google Scholar 

  11. Pollack Jr CV, et al. Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med. 2006;13(1):13–8.

    Article  PubMed  Google Scholar 

  12. Peacock WF, et al. Society of Chest Pain Centers recommendations for the evaluation and management of the observation stay acute heart failure patient—parts 1–6. Acute Card Care. 2009;11(1):3–42.

    Article  PubMed  Google Scholar 

  13. Collins SP, et al. Low-risk acute heart failure patients: external validation of the Society of Chest Pain Center’s recommendations. Crit Pathw Cardiol. 2009;8(3):99–103.

    Article  PubMed  PubMed Central  Google Scholar 

  14. McKee PA, et al. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285(26):1441–6.

    Article  PubMed  CAS  Google Scholar 

  15. Felker GM, et al. Risk stratification after hospitalization for decompensated heart failure. J Card Fail. 2004;10(6):460–6.

    Article  PubMed  Google Scholar 

  16. Barsheshet A, et al. Admission blood glucose level and mortality among hospitalized nondiabetic patients with heart failure. Arch Intern Med. 2006;166(15):1613–9.

    Article  PubMed  Google Scholar 

  17. Fermann GJ, Collins SP. Observation units in the management of acute heart failure syndromes. Curr Heart Fail Rep. 2010;7(3):125–33.

    Article  PubMed  Google Scholar 

  18. Selker HP, Griffith JL, D’Agostino RB. A time-insensitive predictive instrument for acute hospital mortality due to congestive heart failure: development, testing, and use for comparing hospitals: a multicenter study. Med Care. 1994;32(10):1040–52.

    Article  PubMed  CAS  Google Scholar 

  19. Fonarow GC, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293(5):572–80.

    Article  PubMed  CAS  Google Scholar 

  20. Gheorghiade M, et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006;296(18):2217–26.

    Article  PubMed  CAS  Google Scholar 

  21. Vital FM, et al. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema. Cochrane Database Syst Rev. 2008;3:CD005351.

    PubMed  Google Scholar 

  22. Masip J, et al. Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary edema: a randomized trial. Lancet. 2000;356(9248):2126–32.

    Article  PubMed  CAS  Google Scholar 

  23. Mak S, et al. Effect of hyperoxia on left ventricular function and filling pressures in patients with and without congestive heart failure. Chest. 2001;120(2):467–73.

    Article  PubMed  CAS  Google Scholar 

  24. Formiga F, et al. Predictors of in-hospital mortality present at admission among patients hospitalised because of decompensated heart failure. Cardiology. 2007;108(2):73–8.

    Article  PubMed  Google Scholar 

  25. Szczech LA, et al. Acute kidney injury and cardiovascular outcomes in acute severe hypertension. Circulation. 2010;121(20):2183–91.

    Article  PubMed  Google Scholar 

  26. Damman K, et al. Tubular damage in chronic systolic heart failure is associated with reduced survival independent of glomerular filtration rate. Heart. 2010;96(16):1297–302.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Gheorghiade M, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J. 2007;28(8):980–8.

    Article  PubMed  CAS  Google Scholar 

  28. Peacock IV WF, et al. Cardiac troponin and outcome in acute heart failure. N Engl J Med. 2008;358:2117.

    Article  PubMed  CAS  Google Scholar 

  29. Diercks DB, et al. ED patients with heart failure: identification of an observational unit-appropriate cohort. Am J Emerg Med. 2006;24(3):319–24.

    Article  PubMed  Google Scholar 

  30. Maisel AS, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347(3):161–7.

    Article  PubMed  CAS  Google Scholar 

  31. McCullough PA, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation. 2002;106(4):416–22.

    Article  PubMed  Google Scholar 

  32. Maisel AS, et al. Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am Heart J. 2001;141(3):367–74.

    Article  PubMed  CAS  Google Scholar 

  33. Singer AJ, et al. Rapid Emergency Department Heart Failure Outpatients Trial (REDHOT II): a randomized controlled trial of the effect of serial B-type natriuretic peptide testing on patient management. Circ Heart Fail. 2009;2(4):287–93.

    Article  PubMed  CAS  Google Scholar 

  34. Lokuge A, et al. B-type natriuretic peptide testing and the accuracy of heart failure diagnosis in the emergency department. Circ Heart Fail. 2010;3(1):104–10.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gregory J. Fermann MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Fermann, G.J., Collins, S.P. (2012). Observation Unit Admission Inclusion and Exclusion Criteria. In: Peacock, W. (eds) Short Stay Management of Acute Heart Failure. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-627-2_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-61779-627-2_13

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61779-626-5

  • Online ISBN: 978-1-61779-627-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics