Emergency department visits for heart failure and subsequent hospitalization or observation

Saul Blecker, Joseph A. Ladapo, Kelly Doran, Keith S. Goldfeld, Stuart Katz

Research output: Contribution to journalArticle

Abstract

Background: Treatment of acute heart failure in the emergency department (ED) or observation unit is an alternative to hospitalization. Both ED management and observation unit management have been associated with reduced costs and may be used to avoid penalties related to rehospitalizations. The purpose of this study was to examine trends in ED visits for heart failure and disposition following such visits. Methods: We used the National Hospital Ambulatory Medical Care Survey, a representative sample of ED visits in the United States, to estimate rates and characteristics of ED visits for heart failure between 2002 and 2010. The primary outcome was the discharge disposition from the ED. Regression models were fit to estimate trends and predictors of hospitalization and admission to an observation unit. Results: The number of ED visits for heart failure remained stable over the period, from 914,739 in 2002 to 848,634 in 2010 (annual change -0.7%, 95% CI -3.7% to +2.5%). Of these visits, 74.2% led to hospitalization, wheras 3.1% led to observation unit admission. The likelihood of hospitalization did not change during the period (adjusted prevalence ratio 1.00, 95% CI 0.99-1.01 for each additional year), whereas admission to the observation unit increased annually (adjusted prevalence ratio 1.12, 95% CI 1.01-1.25). We observed significant regional differences in likelihood of hospitalization and observation admission. Conclusions: The number of ED visits for heart failure and the high proportion of ED visits with subsequent inpatient hospitalization have not changed in the last decade. Opportunities may exist to reduce hospitalizations by increasing shortterm management of heart failure in the ED or observation unit.

Original languageEnglish (US)
Pages (from-to)901-908.e1
JournalAmerican Heart Journal
Volume168
Issue number6
DOIs
StatePublished - Dec 1 2014

Fingerprint

Hospital Emergency Service
Hospitalization
Heart Failure
Observation
Health Care Surveys
Inpatients
Costs and Cost Analysis

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Emergency department visits for heart failure and subsequent hospitalization or observation. / Blecker, Saul; Ladapo, Joseph A.; Doran, Kelly; Goldfeld, Keith S.; Katz, Stuart.

In: American Heart Journal, Vol. 168, No. 6, 01.12.2014, p. 901-908.e1.

Research output: Contribution to journalArticle

Blecker, Saul ; Ladapo, Joseph A. ; Doran, Kelly ; Goldfeld, Keith S. ; Katz, Stuart. / Emergency department visits for heart failure and subsequent hospitalization or observation. In: American Heart Journal. 2014 ; Vol. 168, No. 6. pp. 901-908.e1.
@article{3686fa193c944e2bba78d36cb850b11c,
title = "Emergency department visits for heart failure and subsequent hospitalization or observation",
abstract = "Background: Treatment of acute heart failure in the emergency department (ED) or observation unit is an alternative to hospitalization. Both ED management and observation unit management have been associated with reduced costs and may be used to avoid penalties related to rehospitalizations. The purpose of this study was to examine trends in ED visits for heart failure and disposition following such visits. Methods: We used the National Hospital Ambulatory Medical Care Survey, a representative sample of ED visits in the United States, to estimate rates and characteristics of ED visits for heart failure between 2002 and 2010. The primary outcome was the discharge disposition from the ED. Regression models were fit to estimate trends and predictors of hospitalization and admission to an observation unit. Results: The number of ED visits for heart failure remained stable over the period, from 914,739 in 2002 to 848,634 in 2010 (annual change -0.7{\%}, 95{\%} CI -3.7{\%} to +2.5{\%}). Of these visits, 74.2{\%} led to hospitalization, wheras 3.1{\%} led to observation unit admission. The likelihood of hospitalization did not change during the period (adjusted prevalence ratio 1.00, 95{\%} CI 0.99-1.01 for each additional year), whereas admission to the observation unit increased annually (adjusted prevalence ratio 1.12, 95{\%} CI 1.01-1.25). We observed significant regional differences in likelihood of hospitalization and observation admission. Conclusions: The number of ED visits for heart failure and the high proportion of ED visits with subsequent inpatient hospitalization have not changed in the last decade. Opportunities may exist to reduce hospitalizations by increasing shortterm management of heart failure in the ED or observation unit.",
author = "Saul Blecker and Ladapo, {Joseph A.} and Kelly Doran and Goldfeld, {Keith S.} and Stuart Katz",
year = "2014",
month = "12",
day = "1",
doi = "10.1016/j.ahj.2014.08.002",
language = "English (US)",
volume = "168",
pages = "901--908.e1",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Emergency department visits for heart failure and subsequent hospitalization or observation

AU - Blecker, Saul

AU - Ladapo, Joseph A.

AU - Doran, Kelly

AU - Goldfeld, Keith S.

AU - Katz, Stuart

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Background: Treatment of acute heart failure in the emergency department (ED) or observation unit is an alternative to hospitalization. Both ED management and observation unit management have been associated with reduced costs and may be used to avoid penalties related to rehospitalizations. The purpose of this study was to examine trends in ED visits for heart failure and disposition following such visits. Methods: We used the National Hospital Ambulatory Medical Care Survey, a representative sample of ED visits in the United States, to estimate rates and characteristics of ED visits for heart failure between 2002 and 2010. The primary outcome was the discharge disposition from the ED. Regression models were fit to estimate trends and predictors of hospitalization and admission to an observation unit. Results: The number of ED visits for heart failure remained stable over the period, from 914,739 in 2002 to 848,634 in 2010 (annual change -0.7%, 95% CI -3.7% to +2.5%). Of these visits, 74.2% led to hospitalization, wheras 3.1% led to observation unit admission. The likelihood of hospitalization did not change during the period (adjusted prevalence ratio 1.00, 95% CI 0.99-1.01 for each additional year), whereas admission to the observation unit increased annually (adjusted prevalence ratio 1.12, 95% CI 1.01-1.25). We observed significant regional differences in likelihood of hospitalization and observation admission. Conclusions: The number of ED visits for heart failure and the high proportion of ED visits with subsequent inpatient hospitalization have not changed in the last decade. Opportunities may exist to reduce hospitalizations by increasing shortterm management of heart failure in the ED or observation unit.

AB - Background: Treatment of acute heart failure in the emergency department (ED) or observation unit is an alternative to hospitalization. Both ED management and observation unit management have been associated with reduced costs and may be used to avoid penalties related to rehospitalizations. The purpose of this study was to examine trends in ED visits for heart failure and disposition following such visits. Methods: We used the National Hospital Ambulatory Medical Care Survey, a representative sample of ED visits in the United States, to estimate rates and characteristics of ED visits for heart failure between 2002 and 2010. The primary outcome was the discharge disposition from the ED. Regression models were fit to estimate trends and predictors of hospitalization and admission to an observation unit. Results: The number of ED visits for heart failure remained stable over the period, from 914,739 in 2002 to 848,634 in 2010 (annual change -0.7%, 95% CI -3.7% to +2.5%). Of these visits, 74.2% led to hospitalization, wheras 3.1% led to observation unit admission. The likelihood of hospitalization did not change during the period (adjusted prevalence ratio 1.00, 95% CI 0.99-1.01 for each additional year), whereas admission to the observation unit increased annually (adjusted prevalence ratio 1.12, 95% CI 1.01-1.25). We observed significant regional differences in likelihood of hospitalization and observation admission. Conclusions: The number of ED visits for heart failure and the high proportion of ED visits with subsequent inpatient hospitalization have not changed in the last decade. Opportunities may exist to reduce hospitalizations by increasing shortterm management of heart failure in the ED or observation unit.

UR - http://www.scopus.com/inward/record.url?scp=84912114295&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84912114295&partnerID=8YFLogxK

U2 - 10.1016/j.ahj.2014.08.002

DO - 10.1016/j.ahj.2014.08.002

M3 - Article

C2 - 25458654

AN - SCOPUS:84912114295

VL - 168

SP - 901-908.e1

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 6

ER -