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Association of Body Mass Index With Increased Cost of Care and Length of Stay for Emergency Department Patients With Chest Pain and Dyspnea
Study Questions:
Does elevated body mass index (BMI) increase costs and length of stay for patients seen in the emergency room with chest pain and dyspnea?
Methods:
This was a prospective study including four centers. Patients were all adults with complaints of dyspnea and chest pain, who also had nondiagnostic electrocardiograms and no clear diagnosis. Patients were followed for the main outcomes for 90 days. Outcomes that were stratified by BMI in five categories (underweight, normal weight, overweight, obese, and morbidly obese) were compared using the Kruskall–Wallis rank test, and the independent predictive value of BMI was tested with multivariate regressions.
Results:
A total of 851 patients were enrolled; however, 22 patients were excluded for missing data on height and/or weight, leaving 829 (57% female, mean age 49 years, and 40% were white). The median BMI was 29.9 kg/m2, and the mean BMI was 31.0 kg/m2 (standard deviation 8.12 kg/m2). The overall rate of diagnosis of acute coronary syndrome within 90 days was 2.8% (0.0%, 3.0%, 4.9%, 2.3%, and 0.0% for underweight, normal weight, overweight, obese, and morbidly obese patients, respectively). The overall rate of diagnosis of pulmonary embolism within 90 days was 1.7% (0.0%, 1.2%, 0.4%, 3.1%, and 1.9% for underweight, normal weight, overweight, obese, and morbidly obese patients, respectively). Morbidly obese patients without computed tomographic (CT) scanning stayed in the hospital 34% longer than normal weight patients (p = 0.073), and morbidly obese patients with CT scanning stayed in the hospital 44% longer than normal weight patients (p = 0.083). BMI was not a significant predictor of radiation exposure. Morbidly obese patients had the highest proportion (87%) of no significant cardiopulmonary diagnosis for 90 days after CT pulmonary angiography. Compared with medical costs for normal weight patients, costs were 22% higher for overweight patients (p = 0.077), 28% higher for obese patients (p = 0.020), and 41% higher for morbidly obese patients (p = 0.015).
Conclusions:
The investigators concluded that BMI was associated with increases in cost of care and length of hospital stay for patients with chest pain and dyspnea. These results emphasize a need for specific protocols to manage morbidly obese patients presenting to the emergency department with chest pain and dyspnea.
Perspective:
As the authors point out, excess weight can cloud the interpretation of diagnostic studies often ordered in the evaluation of chest pain and shortness of breath. Therefore, it is not surprising that increased BMI is associated with increased costs. It makes sense to examine BMI in research related to costs of diagnostic testing for these potentially cardiac symptoms.
Keywords: Acute Coronary Syndrome, Thinness, Body Mass Index, Chest Pain, Overweight, Obesity, Morbid, Pulmonary Embolism, Body Weight, Emergency Service, Hospital, Dyspnea, Length of Stay
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