The hospital course and short term prognosis of patients presenting to the emergency room with decompensated congestive heart failure.

Objectives: This observational study was done to describe the characteristics, hospital course and short term prognosis of patients presenting to an emergency room with decompensated heart failure and to determine the parameters influencing the length of their hospital stay.
Design: The routine clinical and laboratory characteristics of consecutive patients presenting to an emergency room with decompensated heart failure were documented and the patients followed for six months.
Setting: One teaching hospital and one community-based hospital in Montreal, Quebec.
Patients: A prospective cohort of 153 consecutive patients presenting to the emergency room with decompensated heart failure. Follow-up was by clinic visit and telephone survey at one, three and six months. Follow-up was 100%.
Measures of Outcome: Length of hospital stay, in-hospital mortality, readmissions and after hospital discharge deaths were measured.
Results: The average length of hospital stay was 6.2 days with a skewed distribution ranging from one to 56 days. A multivariate analysis showed that the length of hospital stay was associated with increasing left atrial size (P < 0.05), an ischemic etiology of the heart failure (P < 0.03) and a slow response to diuretic therapy (P < 0.001). This mathematical model accounted for only a small amount of hospital stay variability (R2 = 0.22). Six month mortality and morbidity of these patients was high, with 23% dying and 30% readmitted for heart failure, but was independent of the duration of the initial hospitalization.
Conclusions: This prospective study confirms that the hospital course for congestive heart failure is shortening. The six month prognosis of patients presenting to an emergency room for decompensated heart failure is poor and appears independent of the length of hospital stay.