Letter by Pang et al regarding article, "Early deaths in heart failure patients discharged from the emergency department: a population-based analysis".
Letter by Pang et al regarding article, "Early deaths in heart failure patients discharged from the emergency department: a population-based analysis".
复制标题
Pang 等人关于文章“急诊室出院的心力衰竭患者的早期死亡：基于人群的分析”的信函。
DOI：
10.1161/circheartfailure.110.945865
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Storrow,AlanB
中科院分区：
文献类型：
--
作者：
Pang,PeterS;Collins,SeanP;Storrow,AlanB
Lee等1的分析强调了急诊科急性心力衰竭综合征管理的关键挑战：谁可以安全出院？我们对急诊室就诊的心力衰竭患者进行准确风险分层的能力非常差，因为这些患者大多数都是住院患者。[2]我们同意需要更好的风险分层;然而，作者只概述了更好的高风险判别因素的重要性，这意味着没有高风险等于低风险。如前所述，多项研究揭示了心力衰竭住院患者预后不良的预测因素。虽然细化显然是必要的，特别是在急诊科的背景下，李等人的分析表明，尽管有大量的文献定义的高风险预测因子，缺乏这些因素显然不会导致低风险患者的识别。虽然我们认识到这种说法是对令人印象深刻的分析的过度简化，但进一步识别高风险需要与定义低风险患者相协调。3-5提高急诊医生适当管理所有心力衰竭患者的流动的能力不仅是避免不必要的住院和节省医疗资源的基础，而且也是确保为可以安全出院的患者提供最高质量的护理的基础。
The analysis by Lee et al1 highlighted a critical challenge in emergency department acute heart failure syndrome management: Who can be safely discharged? Our ability to accurately risk stratify patients with heart failure presenting to the emergency department is extremely poor because the majority of these patients are admitted to an inpatient setting. 2 We agree that better risk stratification is needed; however, the authors only outline the importance of better discriminators of high risk, implying that the absence of high risk equals low risk. As noted, multiple studies have revealed predictors of worse prognosis in patients hospitalized with heart failure. Although refinement clearly is necessary, especially within the context of the emergency department, the analysis by Lee et al suggested that despite an abundance of literature defining high-risk predictors, absence of these factors clearly did not result in identification of the low-risk patient. Although we recognize that this statement is an oversimplification of an impressive analysis, further identification of high risk needs to occur in harmony with defining the low-risk patient. 3–5 Improving the ability of the emergency physician to appropriately manage the flow of all patients with heart failure is fundamental not only to avoid unnecessary hospitalizations and conserve healthcare resources, but also to ensure the highest quality of care for patients who can be safely discharged.