SSU-AHF
Trial question
What is the role of short-stay units in lower-risk patients with acute HF?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
41.0% female
59.0% male
N = 193
193 patients (79 female, 114 male).
Inclusion criteria: low-risk patients with acute HF.
Key exclusion criteria: transplanted organ of any kind or ventricular assist device; ESRD; acute coronary syndrome; other acute comorbid conditions; pregnancy; de novo acute HF; planned discharge from emergency department.
Interventions
N=93 short-stay unit (post-emergency department disposition to < 24 hours of short-stay unit care).
N=100 hospitalization (hospital admission from the emergency department).
Primary outcome
Quality-of-life as measured by 12-item Kansas City Cardiomyopathy Questionnaire at day 30
51.3
45.8
51.3
38.5
25.6
12.8
0.0
Short-stay
unit
Hospitalization
No significant
difference ↔
No significant difference in quality-of-life as measured by the 12-item Kansas City Cardiomyopathy Questionnaire at day 30 (51.3 vs. 45.8; MD 5.6, 95% CI -2.75 to 13.95).
Secondary outcomes
Significant increase in median days alive and out of hospital at day 30 (26.9 days vs. 25.4 days; AD 1.6 days, 95% CI 0.25 to 2.95).
No significant difference in death or rehospitalization at day 30 (19% vs. 19.4%; ARD -0.4, 95% CI -9.92 to 9.12).
No significant difference in the rate of unscheduled emergency department visit for HF within 30 days (16.9% vs. 19.4%; ARD -2.5, 95% CI -7 to 2).
Safety outcomes
No significant differences in adverse event, death at day 90.
Conclusion
In low-risk patients with acute HF, short-stay unit was not superior to hospitalization with respect to a quality-of-life as measured by the 12-item Kansas City Cardiomyopathy Questionnaire at day 30.
Reference
Peter S Pang, David A Berger, Simon A Mahler et al. Short-Stay Units vs Routine Admission From the Emergency Department in Patients With Acute Heart Failure: The SSU-AHF Randomized Clinical Trial. JAMA Netw Open. 2024 Jan 2;7(1):e2350511.
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