Quality and Safety in the Literature: July 2021

Abstract

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. EFFECT OF AN EMERGENCY DEPARTMENT CARE BUNDLE ON 30-DAY HOSPITAL DISCHARGE AND SURVIVAL AMONG ELDERLY PATIENTS WITH ACUTE HEART FAILURE: THE ELISABETH RANDOMIZED CLINICAL TRIAL JAMA. 17 November 2020 Heart failure is one of the most common clinical syndromes worldwide; it predominantly affects the elderly, who account for more than 80% of those affected. Older adults with heart failure often have both cardiac and noncardiac comorbidities that make management difficult and adversely affect both morbidity and mortality. Notably, acute heart failure is the leading cause of hospitalisation in individuals over 65 years of age, and about a quarter of these patients are readmitted within 30 days of discharge. 3 As the population has aged, this has led to a significant increase in health system costs. As a result, much quality improvement effort has been focused on finding ways to decrease frequent emergency department (ED) visits and hospitalisations. Although recent data suggest that early treatment of acute heart failure may improve prognosis, the majority of prior clinical trials focused on addressing management of patients within the first 24 to 48 hours of hospital admission instead of on presentation to the ED. 5 In the larger of these studies, results have not shown significant improvement in clinical outcomes 6 despite promising results in smaller studies. 8 Furthermore, elderly patients have been consistently underrepresented in these clinical trials, despite comprising the majority of those affected. In their steppedwedge cluster randomised clinical trial, Freund and colleagues sought to test the efficacy of a guidelinebased, comprehensive care bundle implemented early in the ED visit of older patients presenting with acute heart failure. Patients aged 75 years and older who presented to any of 15 participating EDs in France with a diagnosis Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies recently published in major medical journals. Some articles will focus on a particular theme, whereas others will highlight unique publications from highimpact medical journals.