Ho Edwin C, Schull Michael J, Lee Douglas S
Institute for Clinical Evaluative Sciences, Division of Cardiology, University Health Network, Room G-106, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
Curr Heart Fail Rep. 2012 Sep;9(3):252-9. doi: 10.1007/s11897-012-0100-1.
Acute decompensated heart failure is a common reason for presentation to the emergency department and is associated with high rates of admission to hospital. Distinguishing between higher-risk patients needing hospitalization and lower-risk patients suitable for discharge home is important to optimize both cost-effectiveness and clinical outcomes. However, this can be challenging and few validated risk stratification tools currently exist to help clinicians. Some prognostic variables predict risks broadly in those who are admitted or discharged from the emergency department. Risk stratification methods such as the Emergency Heart Failure Mortality Risk Grade and Acute Heart Failure Index clinical decision support tools, which utilize many of these predictors, have been found to be accurate in identifying low-risk patients. The use of observation units may also be a cost-effective adjunctive strategy that can assist in determining disposition from the emergency department.
急性失代偿性心力衰竭是患者前往急诊科就诊的常见原因，且住院率较高。区分需要住院治疗的高风险患者和适合出院回家的低风险患者对于优化成本效益和临床结局至关重要。然而，这可能具有挑战性，目前几乎没有经过验证的风险分层工具来帮助临床医生。一些预后变量可广泛预测那些从急诊科入院或出院患者的风险。已发现诸如利用许多这些预测因素的急诊心力衰竭死亡率风险分级和急性心力衰竭指数临床决策支持工具等风险分层方法在识别低风险患者方面是准确的。使用观察单元也可能是一种具有成本效益的辅助策略，可有助于确定从急诊科的处置方式。
