TOPLINE:
Quality of life for patients with acute heart failure (AHF) managed in a short-term unit (SSU) is no worse than that for those who are hospitalized, a new randomized trial showed. They also had an increased chance of being alive and out of hospital at 30 days and did not experience more adverse events, results suggested.
METHODOLOGY:
- The multicenter SSU-AHF trial randomized 193 lower-risk patients, mean age of 64.8 years, presenting at the emergency department (ED) with AHF symptoms to an SSU for brief (< 24 h) observation or hospital admission.
- From electronic health records and telephone interviews at 30 days and 90 days, researchers collected data to assess vital status, all-cause rehospitalizations, ED revisits, and quality of life.
- Owing to challenges posed by COVID-19, the primary outcome was changed from days alive and out of hospital (DAOOH) to quality of life, as measured by the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) short form, on which a change of five points is deemed clinically important, and DAOOH became a secondary outcome.
- The composite outcome of all-cause mortality and rehospitalization included time from randomization to either all-cause death or rehospitalization at 30 days and 90 days.
TAKEAWAY:
- At 30 days, KCCQ-12 scores improved in both arms to well above five points, but there was no significant group difference (mean score, 51.3 in 65 SSU patients vs 45.8 in 68 hospitalized patients for a mean difference of 5.6 points; P = .19).
- Participants in the SSU arm had a significant 1.6 more DAOOH than the hospitalized group at 30 days (median, 26.9 days vs 25.4 days; P = .02), which is notable given 41.9% of SSU participants required hospitalization and had a longer combined ED and hospital length of stay, said the authors.
- There were no differences between arms for 30-day all-cause death or rehospitalization (P = .94); by 90 days, there was a total of seven deaths (three in the SSU arm and four in the hospitalization arm).
- Adverse events were relatively rare and didn’t differ significantly between groups (16.1% in SSU vs 16.0% in hospitalization arms).
IN PRACTICE:
“Our findings build on past work where SSU as an alternative to hospitalization from the ED appeared to be a safe option in lower-risk patients with AHF seen in the ED,” but they need to be “definitively tested in an adequately powered study,” the authors wrote.
In an accompanying commentary, Shanshan E. Gustafson, MD, Department of Medicine, Kaiser Permanente Mid-Atlantic Medical Group, Gaithersburg, Maryland, and others agreed the findings suggest SSU management may be a safe alternative to hospital admission for selected patients with AHF and noted this strategy could extend beyond traditional care settings, “with hospital at home (HaH) emerging as a promising, value-driven, and potentially well-suited care model for the management of AHF.”
SOURCE:
The study was conducted by Peter S. Pang, MD, MS, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, and colleagues. It was published online on January 10, 2024, in JAMA Network Open.
LIMITATIONS:
The relatively small study sample size mitigates robust conclusions, and the neutral findings may be a result of type II error. The COVID-19 pandemic required significant changes to the study design including a change in the primary outcome, and lower-than-expected enrollment left the study underpowered to detect a significant difference in KCCQ-12 scores. There was also a lower-than-expected completion of the KCCQ-12. Researchers did not assess resource use and caregiver burden.
DISCLOSURES:
The study was supported by the Agency for Healthcare Research and Quality. Pang reported receiving grants from the American Heart Association and National Heart, Lung, and Blood Institute and personal fees from Roche, Kowa Pharma, Eagle Pharma, and the Heart Initiative; being 5% owner of the Heart Course; receiving grants from Beckman Coulter, Siemens, and Ortho Clinical Diagnostics; and being an advisor for WebMD. See paper for disclosures of other study authors. Gustafson had no relevant conflicts of interest; see commentary for disclosures of the two other authors.