Frequent Utilization of the Emergency Department for Acute Heart Failure Syndrome: A Population-Based Study

Study Questions:

Among patients with heart failure and at least one emergency department (ED) visit for acute heart failure syndrome (AHFS), what proportion of patients had additional visits during 1-year follow-up, and what were characteristics of patients with frequent (≥2) visits?

Methods:

This was a retrospective cohort study using data from the Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) and State Inpatient Databases from California and Florida. Patients with at least one ED visit for AHFS in 2010 were identified. The primary outcome measure was the frequency of ED visits for AHFS in a given year for each patient; each patient was followed for 1 year following the index visit. Patients were categorized into three groups based on their number of ED visits for AHFS: one ED visit (i.e., index visit only), two ED visits, and ≥3 visits.

Results:

The final analytic sum comprised 113,033 unique patients with 175,491 ED visits for AHFS; 30.8% (95% confidence interval, 30.5-31.1%) had ≥2 ED visits. Significant predictors of frequent ED visits were non-Hispanic black race, Hispanic ethnicity, and markers of low socioeconomic status (including Medicaid insurance and lower household income). In Florida, the total charges for ED and inpatient services for AHFS were $3.08 billion, with frequent ED visits accounting for the majority of charges (53.3%; 95% confidence interval, 53.2-53.3%).

Conclusions:

Among patients with an index ED visit, about one third (31%) had frequent ED visits in the following year. Minority race and markers of socioeconomic status were predictive of increased frequency of ED visits.

Perspective:

Most research on patients with AHFS has examined readmissions. This is an important study that may recalibrate this strategy by illustrating that it is necessary to examine ED visits to more completely understand healthcare utilization in HF patients. The burden of frequent ED visits was significant in this study. The authors caution that an unintended consequence of current reform efforts directed at incentivizing reduction in readmissions may shift patient care to the ED. Future strategies should be integrative and should target multiple levels of healthcare utilization.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Outcome Assessment (Health Care), Patient Care, California, Florida, Medicaid, Heart Failure, Health Care Costs, Emergency Service, Hospital, Hispanic Americans, Cost of Illness, Social Class


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