Date of Project Completion

Spring 4-13-2021

Document Type

Project Paper

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Carole E. Jenson

Second Advisor

Ann R. Loth

City

Rochester

Abstract

Background

Heart Failure (HF) is a primary diagnosis for hospital admission in adults from the Emergency Department (ED), but not all patients require hospitalization. Emergency Heart Failure Mortality Risk Grade (EHMRG) is designed to estimate mortality in patients with acute HF in ED settings.

Objectives

To risk-stratify patients with acute HF using EHMRG scores and assess patient safety.

Methods

Retrospective cohort analysis of 304 patients with acute HF presenting to an ED at a large tertiary healthcare center. EHMRG scores were calculated per previous thresholds. Mortality and Major Adverse Cardiac Event (MACE) rates were analyzed.

Results

EHMRG risk group respective seven-day mortality rates 0.0% in very low and low-risk groups. Mortality and MACE rates are significantly less in lower-risk groups at 30 days.

Conclusions

ED risk stratification with EHMRG has the potential to revolutionize care for patients with acute HF. Lower-risk patients may be safely discharged or treated in ED observation units (EDOUs).

Comments

Acknowledgements: The author would like to thank Dr. Carol Jenson and Dr. Ann Loth as committee co-chairs, and Dr. Kimberly Langer as a WSU faculty committee member. Dr. Bo Madsen and Dr. Stephen Kopecky for support of this project and their clinical expertise in Emergency Medicine and Cardiology; Michele Yeadon APRN, CNP for providing support and clinical expertise as the DNP project site mentor; Angela Fink APRN, CNP and Dr. Casey Clements for offering clinical expertise and insight at the healthcare institution; Aidan Mullan for statistical analysis; Jennifer Condon, Quality Performance Analyst for assistance with clinical data; Alison Schultz, Statistic Program Analyst for developing data queries to obtain data; Diana Albers, Cardiovascular Clinical Research Coordinator for assistance with data entry; and Dr. Michael Osborn for funding support.

Funding: This work was supported by Mayo Clinic (funding from commercial grant awarded to Mayo Clinic).

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Nursing Commons

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