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New Decision Guidelines for Predicting Low-Risk Patients with Heart Failure Could Save the Health Care Industry Billions of Dollars

BOSTON, June 1, 2003 New decision guidelines for identifying patients with low-risk heart failure may prevent unnecessary hospitalizations and could significantly reduce health care-related expenses, which according to the National Heart Lung and Blood Institute, cost the industry an estimated $21 billion per year.

These guidelines are coming out of a study being presented by University of Pittsburgh researchers today at the 2003 Annual Meeting of the Society of Academic Emergency Medicine (SAEM) in Boston.

Heart failure is the primary reason for hospital admissions of 1 million patients each year in the United States. Most of these patients are 65 years of age and older, an age segment expected to expand over the next several decades, putting even more strain on the health care system. Approximately 70 percent are first treated in the emergency department, making it an ideal setting for a heart failure clinical decision guideline to help physicians identify low-risk patients who could be treated at home, a much less costly alternative.

The Pitt researchers sought to build a clinical decision guideline based on data collected from the emergency department to identify patients with heart failure who are at low risk of inpatient death or serious medical complications. Based on more than 33,000 cases of heart failure patients, they developed a guideline based on data collected in the emergency department that identified nearly 16 percent as low risk.

Treatments for heart failure can improve the quality of life for people with this condition but cannot stop the progression. The number of patients seeking treatment in the emergency department for this disease will likely spiral upward as the elderly population continues to grow, said Thomas E. Auble, Ph.D., research assistant professor of the department of emergency medicine at the University of Pittsburgh School of Medicine and one of the study investigators.

Through this study we have successfully developed a clinical decision guideline that will enable emergency medicine physicians to identify patients with low-risk heart failure so they can go home rather than endure needless hospital stays.

Variable hospital admission rates and inaccurate physician estimates of prognosis for patients with heart failure suggest that a clinical prediction rule is needed to assist providers with risk assessment and hospitalization decisions, said Donald M. Yealy, M.D., professor and vice chairman of emergency medicine at the University of Pittsburgh School of Medicine and study investigator. Dr. Yealy also is president of the Society of Academic Emergency Medicine.

The researchers teamed with Michael J. Fine, M.D., M.Sc., associate professor of medicine at the University of Pittsburgh School of Medicine and members of the University of Pittsburgh Pneumonia Patient Outcomes Research Team that had used a similar approach to develop a clinical decision guideline for the admission of patients with community-acquired pneumonia. A recently completed study that implemented the guideline in emergency departments in Connecticut and Pennsylvania showed that physicians used it safely to reduce the admission of low-risk patients.

Similar success is anticipated with the new heart failure guidelines, stated Dr. Yealy.

The department of emergency medicine at the University of Pittsburgh School of Medicine, under the direction of Paul Paris, M.D., F.A.C.E.P., is one of the largest academic departments in the United States. Roughly 40,000 patients are treated each year. Department faculty are recognized authorities in many specialty areas of emergency medicine, including prehospital care, pain management, decision guidelines, airway management, toxicology, resuscitation medicine, disaster planning and injury prevention.

The Society of Academic Emergency Medicine is the largest academic emergency medicine physician organization in the world, with more than 5,000 members. The societys mission is to foster emergency medicine's academic environment in research, education and health policy through forums, publications, inter-organizational collaboration, policy development and consultation services for teachers, researchers and students.

Co-investigators of this study include Margaret Hsieh, M.D., and Julie B. McCausland, M.D., department of emergency medicine at the University of Pittsburgh School of Medicine; William Gardner, M.D., and Gregory F. Cooper, M.D., department of medicine at the University of Pittsburgh School of Medicine; and Roslyn Stone, Ph.D., department of biostatistics at the University of Pittsburgh Graduate School of Public Health.

This research was funded by the Agency for HealthCare Research and Quality.

Note to editors: This is moderated poster session number 362 and is being presented at the SAEM meeting from 9 to 10:30 a.m., E.T., Sunday, June 1, at the Marriott Copley Place Hotel in Boston.

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