Cardiology Consultation in the Emergency Department Reduces Re-hospitalizations for Low-Socioeconomic Patients with Acute Decompensated Heart Failure

Am J Med. 2017 Sep;130(9):1112.e17-1112.e31. doi: 10.1016/j.amjmed.2017.03.044. Epub 2017 Apr 27.


Background: Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the emergency department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and health care costs for low-socioeconomic urban patients with acute decompensated heart failure.

Methods: There were 392 patients treated at our center for acute decompensated heart failure who received standardized education and follow-up. Patients who returned to the ED received early consultation with a cardiologist; 392 patients who received usual care served as controls. Thirty- and 90-day re-hospitalization, ED re-visits, heart failure symptoms, mortality, and health care costs were recorded.

Results: Despite guideline-based education and follow-up, the rate of ED re-visits was not different between the groups. However, the rate of re-hospitalization was significantly lower in patients receiving the intervention compared with controls (odds ratio 0.592), driven by a reduction in the risk of readmission from the ED (0.56 vs 0.79, respectively). Patients receiving the intervention accumulated 14% fewer re-hospitalized days than controls and 57% lower 30-day total health care cost. Despite the reduction in health care resource consumption, mortality was unchanged. After accounting for the total cost of intervention delivery, the health care cost savings was substantially greater than the cost of intervention delivery.

Conclusion: Early consultation with a cardiologist in the ED as an adjunct to guideline-based follow-up is associated with reduced re-hospitalization and health care cost for low-socioeconomic urban patients with acute decompensated heart failure.

Keywords: Cost-effectiveness; Heart failure; Re-hospitalization; Readmission.

MeSH terms

  • Acute Disease
  • Aged
  • Cardiology / economics
  • Cardiology / methods
  • Cardiology / standards*
  • Case-Control Studies
  • Chicago
  • Cost Control / methods
  • Cost Control / standards
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Heart Failure / economics
  • Heart Failure / therapy*
  • Humans
  • Male
  • Middle Aged
  • Organizational Case Studies
  • Patient Discharge / economics
  • Patient Discharge / standards
  • Patient Discharge / statistics & numerical data
  • Patient Education as Topic / economics
  • Patient Education as Topic / methods
  • Patient Education as Topic / organization & administration*
  • Patient Readmission / economics
  • Patient Readmission / statistics & numerical data*
  • Practice Guidelines as Topic
  • Propensity Score
  • Referral and Consultation / economics
  • Referral and Consultation / standards
  • Retrospective Studies
  • Socioeconomic Factors
  • Tertiary Care Centers / economics
  • Tertiary Care Centers / organization & administration
  • Urban Health / economics
  • Urban Health / statistics & numerical data