Many acute HF patients overuse emergency departments

Approximately one-third of patients who present to the emergency department with acute heart failure syndrome are frequent ED users, and they account for "an enormous burden of health care utilization and expenditures," according to a report published online Aug. 19 in Circulation: Cardiovascular Quality and Outcomes.

Frequent ED use for this condition reflects a failure in secondary prevention and is considered to be preventable with good-quality longitudinal management, said Dr. Kohei Hasegawa of the department of emergency medicine, Massachusetts General Hospital and Harvard Medical School, Boston.

Dr. Hasegawa and his colleagues assessed the frequency of ED usage by analyzing information from two large databases, focusing on 113,033 adults who made 175,491 ED visits for acute HF syndrome in California and Florida during a 1-year period. Most of these patients (69%) required only one ED visit during that time, but the remaining 31% were frequent users (overusers) who had at least two visits, accounted for more than half of all ED visits and hospitalizations for this condition, and accounted for 58% of all near-fatal events.

In this study, if recurrent ED visits after the index visit had been prevented by better quality longitudinal care, "up to 62,458 ED visits and 53,234 hospitalizations would have been saved annually in [these] two states alone. In terms of expenditures, this would have saved $1.06 billion, in Florida alone," Dr. Hasegawa and his associates said (Circ. Cardiovasc. Qual. Outcomes 2014 Aug. 19 [doi: 10.1161/Circoutcomes.114.000949]).

Frequent users were more likely to be male than female; to be black or Hispanic than other races/ethnicities; to have several markers of low socioeconomic status such as low income and Medicaid insurance; and to have several comorbid conditions such as chronic pulmonary disease, renal failure, diabetes, depression, and drug abuse.

"Although the pathway through which socioeconomic status and health care–related factors affect health care utilization is undoubtedly complex, studies in other chronic conditions suggest that less self-management education and limited access to preventive care in this population might lead to a heavier reliance on episodic treatment in the ED," the investigators said.

This study was supported in part by the Eleanor and Miles Shore Fellowship Program and the Honjo International Scholarship Foundation. Dr. Hasegawa and his associates reported no financial conflicts of interest.

Approximately one-third of patients who present to the emergency department with acute heart failure syndrome are frequent ED users, and they account for "an enormous burden of health care utilization and expenditures," according to a report published online Aug. 19 in Circulation: Cardiovascular Quality and Outcomes.

Frequent ED use for this condition reflects a failure in secondary prevention and is considered to be preventable with good-quality longitudinal management, said Dr. Kohei Hasegawa of the department of emergency medicine, Massachusetts General Hospital and Harvard Medical School, Boston.

Dr. Hasegawa and his colleagues assessed the frequency of ED usage by analyzing information from two large databases, focusing on 113,033 adults who made 175,491 ED visits for acute HF syndrome in California and Florida during a 1-year period. Most of these patients (69%) required only one ED visit during that time, but the remaining 31% were frequent users (overusers) who had at least two visits, accounted for more than half of all ED visits and hospitalizations for this condition, and accounted for 58% of all near-fatal events.

In this study, if recurrent ED visits after the index visit had been prevented by better quality longitudinal care, "up to 62,458 ED visits and 53,234 hospitalizations would have been saved annually in [these] two states alone. In terms of expenditures, this would have saved $1.06 billion, in Florida alone," Dr. Hasegawa and his associates said (Circ. Cardiovasc. Qual. Outcomes 2014 Aug. 19 [doi: 10.1161/Circoutcomes.114.000949]).

Frequent users were more likely to be male than female; to be black or Hispanic than other races/ethnicities; to have several markers of low socioeconomic status such as low income and Medicaid insurance; and to have several comorbid conditions such as chronic pulmonary disease, renal failure, diabetes, depression, and drug abuse.

"Although the pathway through which socioeconomic status and health care–related factors affect health care utilization is undoubtedly complex, studies in other chronic conditions suggest that less self-management education and limited access to preventive care in this population might lead to a heavier reliance on episodic treatment in the ED," the investigators said.

This study was supported in part by the Eleanor and Miles Shore Fellowship Program and the Honjo International Scholarship Foundation. Dr. Hasegawa and his associates reported no financial conflicts of interest.

Approximately one-third of patients who present to the emergency department with acute heart failure syndrome are frequent ED users, and they account for "an enormous burden of health care utilization and expenditures," according to a report published online Aug. 19 in Circulation: Cardiovascular Quality and Outcomes.

Frequent ED use for this condition reflects a failure in secondary prevention and is considered to be preventable with good-quality longitudinal management, said Dr. Kohei Hasegawa of the department of emergency medicine, Massachusetts General Hospital and Harvard Medical School, Boston.

Dr. Hasegawa and his colleagues assessed the frequency of ED usage by analyzing information from two large databases, focusing on 113,033 adults who made 175,491 ED visits for acute HF syndrome in California and Florida during a 1-year period. Most of these patients (69%) required only one ED visit during that time, but the remaining 31% were frequent users (overusers) who had at least two visits, accounted for more than half of all ED visits and hospitalizations for this condition, and accounted for 58% of all near-fatal events.

In this study, if recurrent ED visits after the index visit had been prevented by better quality longitudinal care, "up to 62,458 ED visits and 53,234 hospitalizations would have been saved annually in [these] two states alone. In terms of expenditures, this would have saved $1.06 billion, in Florida alone," Dr. Hasegawa and his associates said (Circ. Cardiovasc. Qual. Outcomes 2014 Aug. 19 [doi: 10.1161/Circoutcomes.114.000949]).

Frequent users were more likely to be male than female; to be black or Hispanic than other races/ethnicities; to have several markers of low socioeconomic status such as low income and Medicaid insurance; and to have several comorbid conditions such as chronic pulmonary disease, renal failure, diabetes, depression, and drug abuse.

"Although the pathway through which socioeconomic status and health care–related factors affect health care utilization is undoubtedly complex, studies in other chronic conditions suggest that less self-management education and limited access to preventive care in this population might lead to a heavier reliance on episodic treatment in the ED," the investigators said.

This study was supported in part by the Eleanor and Miles Shore Fellowship Program and the Honjo International Scholarship Foundation. Dr. Hasegawa and his associates reported no financial conflicts of interest.