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Race, socioeconomic status predicted frequent ED use for acute HF
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Minority race or ethnicity and lower socioeconomic status were associated with frequent visits to the ED for acute HF syndrome, according to results of a retrospective study of patients in California and Florida.
Kohei Hasegawa, MD, MPH, from the department of emergency medicine at Massachusetts General Hospital, and colleagues performed a retrospective cohort study of adults with at least one ED visit for acute HF syndrome between 2010 and 2011 as identified by the State Emergency Department Databases or the State Inpatient Databases in California and Florida (n=113,033 patients with 175,491 visits). Those states were selected because of their large and diverse populations, according to the researchers.
Kohei Hasegawa
The primary outcome measure was frequency of ED visits for acute HF syndrome in a given year for each patient, beginning with the index visit in 2010 and continuing through 1 year of follow-up after the index visit. Patients were stratified by whether they had one visit, two visits or three or more visits within 1 year.
During follow-up, 30.8% of patients had at least two ED visits for acute HF syndrome. This group accounted for 55.4% (95% CI, 55.2-55.5) of all ED visits for acute HF syndrome. In a multivariable model, non-Hispanic black race, Hispanic ethnicity, Medicaid insurance and lower median household income were identified as significant predictors of frequent ED visits (P<.001 for all).
Patients with at least two ED visits for acute HF syndrome within 1 year accounted for 55% (95% CI, 54.8-55.3) of all acute HF syndrome hospitalizations via the ED, according to the researchers.
The study also evaluated charges related to acute HF syndrome. In the Florida study population, total charges for acute HF syndrome were $3.08 billion (95% CI, 3.03 billion-3.14 billion) during the study period, and patients with frequent ED visits accounted for 53.3% (95% CI, 53.2-53.3) of the total charges.
Compared with hospital admissions, “frequent ED visits better reflect the failure of more prevention-oriented care and, accordingly, may serve as a patient-oriented metric,” Hasegawa and colleagues wrote. “This metric may assist ongoing efforts to decrease hospitalizations for [HF].”
Disclosure: The researchers report no relevant financial disclosures.
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