See Article by Sax et al

I always avoid prophesying beforehand because it is much better to prophesy after the event has already taken place.

—Winston Churchill

Over 50% of all hospital admissions originate from the emergency department (ED), supporting the popular belief that the ED admits too many patients. Although the ED is the source of most admissions,¹ the truth is most patients seen in the ED actually go home. Of 141 million annual visits to EDs in the United States, only 12.6% result in admission.² When it comes to acute heart failure (AHF), however, the perceived reality is in fact true. The ED admits ≈85% of patients who present with AHF, accounting for ≈80% of the >1 million AHF hospitalizations per year.^3,4 Many patients with AHF clearly require acute care; but is it truly 8 of every 10 patients?

What do the data tell us? Unfortunately, little. Despite countless assertions that more patients with AHF should be sent home, supporting evidence is lacking.^5,6 The most robust data come from our Canadian colleagues^7,8; perhaps, we should simply extrapolate their data to the US setting. However, this highlights the surprising paucity of US data on outcomes of patients discharged from the ED with AHF. If we do extrapolate, current data suggest that patients discharged from the ED have worse outcomes than hospitalized patients!⁷ Our clinical gestalt to discriminate high from low risk seems poor.

Unlike chest pain and the rule-out risk-scores or risk-stratification instruments for acute coronary syndromes, no universally accepted tools exist for AHF.⁹ Several promising ED-based AHF risk instruments have been proposed both outside and within the United States^8,9 but are not ready for prime time. They either (1) have …

见萨克斯等人的文章

我总是避免事先做预言，因为在事件已经发生之后进行预言会好得多。

-温斯顿·丘吉尔

所有医院住院病人中有50％以上来自急诊科（ED），这支持了普遍的看法，即急诊科收治的病人过多。尽管急诊室是大多数入院的源头，¹事实是急诊室中看到的大多数患者实际上都回家了。在美国，每年1.41亿次对ED的访问中，只有12.6％的结果被录取。²然而，谈到急性心力衰竭（AHF）时，所感知的事实实际上是真实的。急诊部接受了约85％的AHF患者，约占每年超过100万例AHF住院患者的80％。^3，4，许多患者AHF显然需要紧急护理; 但是真的是每10位病人中有8位吗？

数据告诉我们什么？不幸的是，很少。尽管无数次断言应将更多的AHF患者送回家，但缺乏支持证据。^5，6，最可靠的数据来自于我们的加拿大同事^7，8 ; 也许，我们应该简单地将其数据外推到美国。然而，这突显了美国有关AHF急诊出院患者结局的数据令人惊讶。如果我们进行推断，当前数据表明从ED出院的患者比住院患者的预后更差！⁷我们将高危险与低危险区分开的临床格式塔似乎很差。

与胸痛和用于急性冠状动脉综合征的排除风险评分或风险分层工具不同，AHF没有普遍接受的工具。⁹几个有前途的基于ED-AHF风险投资工具已经提出的两项之外，在美国^8，9，但不准备为黄金时间。他们要么（1）有……