Grant: Operating Grant

Shortness of breath is a common problem in the emergency department (ED) and is associated with important conditions like heart failure (HF) and chronic obstructive pulmonary disease (COPD). These conditions have high rates of death and serious outcomes, particularly in older patients who often require hospital admission. Because there is a significant shortage of hospital beds, physicians in Canadian EDs are under great pressure to send home HF and COPD patients. Many such patients discharged from the ED suffer poor outcomes or return to the ED and require admission. Hence, the decision to admit or discharge a patient from the ED is very important. There is, however, little evidence to guide decisions on patient admission. In our CIHR-funded RAD Study Phase 1, using careful data collection and statistical analysis of 1,500 patients, we developed risk scoring systems to predict poor outcomes. These Canadian HF and COPD Risk Scales, consisting of 10 clinical findings each, will allow physicians to estimate the risk for poor outcomes as high, medium, or low and to make better admission decisions. The HF and COPD Risk Scales must now be tested in new patient populations before they can be applied in clinical practice. There are two goals for this renewal application (RAD-2 Study). First, we wish to prospectively test the accuracy, reliability, and acceptability of the HF and COPD Risk Scales in ED patients. Second, we wish to evaluate in detail the safety of current admission practices. This study will take place in the EDs of five Canadian hospitals and involve 2,500 adults aged > 50 years, who are diagnosed with HF or COPD. Patients will be assessed for the two new scoring systems as well as for standardized clinical and laboratory variables. We expect these guidelines, once tested, will be widely used and will improve and standardize admission practices for these patients, diminishing both unnecessary admissions as well as unsafe discharge decisions.