The Burden of Acute Heart Failure on U.S. Emergency Departments

Study Questions:

What are the emergency department (ED) admission rates, lengths of stay (LOS), and costs for acute heart failure (AHF)?

Methods:

The study investigators used Nationwide Emergency Department Sample AHF data from 2006-2010 to determine: admission proportion, hospital LOS, and ED charges as a surrogate for resource utilization. They compared results across US regions, patient insurance status, and hospital characteristics.

Results:

The investigators found that there were 958,167 mean annual ED visits for AHF in the United States. The median age was 75.1 years (interquartile range [IQR], 62.5-83.7 years) and 51% were female; 83.7% (95% confidence interval, 83.1-84.2%) were admitted; the median LOS was 3.4 days (IQR, 1.9-5.8 days). There was a small decrease in median LOS (0.09 days) when comparing 2006 with 2010, but the proportion admitted did not change. They found that the odds of admission, adjusting for age, sex, hospital characteristic (academic and safety net status), and insurance (Medicare, Medicaid, Private, Self Pay/No Charge), were highest in the Northeast. Median ED charges were $1,075 (IQR, $679-1,665) in 2006, and $,1558 ($1,018-2,335) in 2010. They also found that patients without insurance were more likely to be discharged from the ED, but, when admitted, were more likely to receive a major diagnostic or therapeutic procedure.

Conclusions:

The authors concluded that a very high proportion of ED patients with AHF are admitted nationally, with significant variation in disposition and procedural decisions based on region of the country and type of insurance, even after adjusting for potential confounding.

Perspective:

As life expectancy continues to increase, the burden of HF will also increase—it is estimated that among the 4 million US residents who have HF, 70% are over the age of 60 years (Am Heart J 1999;137:352-60). This study describing the burden of HF in the ED is important because it provides information for both insurance companies and hospitals with EDs, with how best they should allocate resources to decrease LOS and readmissions for HF. The findings of this study should also be helpful for developing a multicenter prospective registry, and for developing cost-effective models of HF management.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Insurance Coverage, Life Expectancy, Medicaid, Heart Failure, Emergency Service, Hospital, Confidence Intervals, Medicare, Cost of Illness, Hospitalization, United States, Length of Stay


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