Alternative Dispositions for Emergency Department Patients.

Alternatives to inpatient admission have been shown to be safe and effective for a variety of clinical conditions and can help relieve emergency department (ED) and inpatient crowding. Evidence-based alternatives include use of rapid ED follow-up clinics, observation units, and home hospital programs. Use of accelerated diagnostic pathways and shared decision making can help support clinicians and patients in appropriately choosing an alternative disposition to traditional inpatient admission. However, many institutions struggle to fully embrace possible alternative depositions because of challenges of patient access, clinician and patient comfort with diagnostic uncertainty, and perceived medicolegal risks.

Diagnosis and Management of Acute Heart Failure in Sub-Saharan Africa.

PURPOSE OF REVIEW: Acute heart failure (AHF) is a common emergency presentation in Sub-Saharan Africa (SSA). In the current review, we present the most recent data on the epidemiology of AHF in SSA and discuss recommended approaches to management in resource-limited settings, with a particular focus on primary and secondary facilities (e.g., health centers and district hospitals), where these patients often present. RECENT FINDINGS: AHF in SSA is most often due to hypertension, cardiomyopathies, and rheumatic heart disease. The etiology of AHF may be different in rural as compared with urban settings. Diagnostic tools for AHF are often lacking in SSA, especially at the first-level facilities. Point-of-care ultrasound (POCUS) and biomarker tests, such as brain natriuretic peptide (BNP), offer promise in helping to mitigate diagnostic challenges. POCUS can also help distinguish among types of heart failure and prompt the correct treatment strategy. Many of the drugs and equipment commonly used to treat AHF in resource-rich settings are lacking in SSA. However, some adaptations of commonly available materials may provide temporary alternatives. The epidemiology of AHF in SSA differs from that of high-income settings. Management of AHF at the first-level facility in SSA is an important and understudied problem. Simplified diagnostic and treatment algorithms rooted in knowledge of the local epidemiology should be developed and tested as part of broader efforts to combat cardiovascular disease in SSA.