At least, this is how Cardiologists think the Emergency Department should be handling heart failure in The Future.
Specifically, Cardiologists would like us to stop admitting patients with acute exacerbations of established heart failure – and, interestingly, they're a bit apprehensive about discharging them. Their earth-shaking, practice-modifying innovation is this: observation unit management.
This strategy is founded partly out of interest of the patient's well-being, but mostly out of interest for the hospital's financial well-being. In general, heart failure remains one of the most difficult hospital readmissions to prevent. This is important because, suddenly, readmissions within 30 days are no longer reimbursed by CMS. Now, rather than, re-admit patients for free, they've decided the New Fabulous Idea is to place them in outpatient observation status – which is a lower level of reimbursement, but still better than nothing. In addition to the other obviously indicated admissions, they also feel some of the gray area discharges would probably benefit from observation, appropriately noting heart failure patients discharged from the ED are at high risk of having subsequent worsening due to a variety of contributing factors.
Overall, as far as actual patient care, there's probably little difference – somewhat cynically, the entire strategy seems mostly to be an advisory on how to minimize the impact of reimbursement losses from readmissions.
"Is Hospital Admission for Heart Failure Really Necessary? The Role of the Emergency Department and Observation Unit in Preventing Hospitalization and Rehospitalization"
And, just as a rather inspirational aside, this is one of the longest disclosures list I have ever seen for an author:
"Dr. Gheorgiade has received support from Abbott Laboratories, Astellas, AstraZeneca, Bayer Schering Pharma AG, Cardiorentis Ltd., CorThera, Cytokinetics, CytoPherx, Inc., DebioPharm S.A., Errekappa Terapeutici, GlaxoSmithKline, Ikaria, Intersection Medical, Inc, John- son & Johnson, Medtronic, Merck & Co., Inc., Novartis Pharma AG, Ono Pharmaceuticals USA, Otsuka Pharmaceuticals, Palatin Technologies, Pericor Therapeutics, Protein Design Laboratories, sanofi-aventis, Sigma Tau, Solvay Pharmaceuticals, Sticares InterACT, Takeda Pharmaceuticals North America, Inc., and Trevena Therapeutics; and has received significant (>$10,000) support from Bayer Schering Pharma AG, DebioPharm S.A., Medtronic, Novartis Pharma AG, Otsuka Pharmaceuticals, Sigma Tau, Solvay Pharmaceuticals, Sticares InterACT, and Takeda Pharmaceuticals North America, Inc."