Description, feasibility, and effectiveness of a coordinated care pathway for patients with suspected heart failure in the emergency department: a tertiary center experience

Background/ introduction

Heart failure (HF) accounts for 2% of the visits in the emergency department (ED) and carries a high risk of readmission. Guidelines recommend early follow-up after discharge. Effective coordination among care services (Heart Failure Unit -HFU-), General Practitioner GP), and Primary Cardiologist is essential.

Purpose

Describe, assess the feasibility, and evaluate the effectiveness of a post-discharge coordination intervention.

Methods

We conducted an observational cohort study comparing patients discharged after an episode of acute HF from the ED of a tertiary hospital. Patients were allocated to one of two concurrent cohorts: those coordinated through the eUIC tool and those receiving usual care without coordination. The decision to use the virtual coordination tool (eUIC) was made by ED clinicians; however, identical inclusion and exclusion criteria were applied to both cohorts. The intervention consisted of eUIC tool combined with a structured post-discharge follow-up program. All patients were followed for 6 months. The primary effectiveness outcome was a composite of HF-related hospitalizations and cardiovascular mortality.

Results

Between April 2021 and November 2024, the eUIC tool was activated in 160 patients. Of these, 59 (36%) were excluded mainly due to HF diagnosis ruled out (n=20; 12,5%), active follow-up by the palliative care unit (n=16; 10%) and hospital admission (n=10; 6,2%). Of the remaining 101 patients, 66.4% (n=67) were coordinated with the HFU, 23.7% (n=24) with PC, and 9.9% (n=10) with their Primary Cardiologist.

The median time between ED discharge and eUIC form review was 2 days [IQR 1-3]. The time to post-discharge follow-up visit was 9 days [IQR 4.5–15], being longer in HFU-coordinated (10 days [5–19]) than in GP (6 days [5–19]; p<0.01).

For the effectiveness analysis, a control cohort of 527 patients was selected. Of these, 425 were excluded mainly due to HF rule out (n=236; 44%) and hospital admission (n=152; 28%), leaving 99 patients for the analysis.

Baseline characteristics were overall similar between the two groups in terms of age, sex, cardiovascular risk factors, Charlson Comorbidity Index, atrial fibrillation, renal function, and haemoglobin levels. However, patients in the intervention group had significantly lower NT-proBNP levels (3017 [1962–7433] vs. 4729 [2617–9225]; p=0.02) and a significantly higher left ventricular ejection fraction (56% [43–61] vs. 48% [35–57]; p=0.02).

During follow-up, the eUIC cohort showed a significantly lower risk of the composite outcome compared with the control cohort after adjustment for potential confounders (aHR 0.29; 95% CI 0.15–0.56; p<0.001).

Conclusion

The eUIC pathway proved to be a feasible coordination model for patients with acute HF discharged from the ED. and could have an impact on early post discharge HF event reduction. These findings warrant confirmation in larger studies.