For those admitted to the OU, the second triage point is uncharted territory. What is the optimal method for determining readiness to leave the hospital after <24 h? Available discharge risk scores apply only to traditional inpatient stays, with goals of complete decongestion and stabilization of fluid balance on oral diuretic agents, treatment of exacerbating factors, patient education regarding self-management, and titration of neurohormonal antagonists for long-term benefit. These will not all be achieved in a stay of <24 h, so the criteria for defining “adequate,” if not “optimal,” treatment need to be clarified. Are urine output and symptomatic response the most relevant measures? Patients often report symptom relief well before adequate decongestion has occurred, and residual elevation in filling pressures is a major determinant of rates of readmission and subsequent mortality (17). Natriuretic peptide levels correlate strongly with prognosis, but it may not be clear what level would be too high for discharge in a patient with a level low enough to have passed initial triage for observation status. Moreover, recurrent heart failure and related cardiovascular conditions account for only about half of readmissions in patients with heart failure; for the remainder who present with exacerbations of noncardiovascular illness, it remains unclear how the OU strategy should be deployed with regard to the management of medical comorbidities (18). This aspect may be particularly relevant for the nearly half of patients with heart failure with preserved ejection fraction who constitute an increasing proportion of the heart failure burden but have few options for evidenced-based medical treatment.