Better Outpatient Care Needed for Cardiac Patients

A new study suggests that repeat emergency department (ED) visits for acute heart failure syndrome (AHFS) are the result of a lack of appropriate outpatient care.

Researchers at Massachusetts General Hospital (Boston, USA) and Harvard Medical School (Boston, MA, USA) conducted a retrospective cohort study of adults with at least one ED visit for AHFS between 2010 and 2011, derived from population-based and inpatient databases for the states of California and Florida. The researchers then examined the proportion and characteristics of the patients with frequent ED visits for AHFS and associated health-care utilization. In all, the sample comprised 113,033 patients with 175,491 ED visits.

The results showed that during the one-year follow-up period, 30.8% of patients had more than two visits, accounting for 55.4% of all ED visits for AHFS. Significant predictors of frequent ED visits were non-Hispanic black race, Hispanic ethnicity, Medicaid insurance, and lower median household income. At the visit level, the frequent patients accounted for 55% of all AHFS hospitalizations via ED. The study was published on August 19, 2014, in Circulation: Cardiovascular Quality and Outcomes.

“The high proportion of patients with frequent ED visits reflects the failure of current measures to manage heart failure symptoms,” said corresponding author Kohei Hasegawa, MD, MPH, MGH. “Our finding also suggests that quality improvement efforts focusing only on hospital admissions may provide an incomplete picture of the utilization of health care services, by discounting the importance of preadmission ED visits.”

“We estimate that prevention of repeat ED visits by high-quality outpatient care of heart failure symptoms would reduce almost 62,000 ED visits and more than 52,000 hospital admissions in both states, saving more than USD 1 billion in Florida alone,” added Dr. Hasegawa. “The association of frequent ED visits with several markers of lower socioeconomic status suggests that factors such as limited access to outpatient services, financial distress, and differences in personal health behaviors may act as barriers to appropriate follow-up care.”

AHFS, an increase in cardiac symptoms that requires urgent care, account for more than 675,000 ED visits and one million hospitalizations in the United States each year. Most of these AHFS ED visits are preventable through continuing outpatient care. The reduction of hospitalizations for AHFS through prevention and treatment is one of the goals of the US Department of Health and Human Service's “Healthy People 2020” program.

Related Links:
Massachusetts General Hospital
Harvard Medical School