Abstract 204: Emergency Department Visits for Heart Failure and Subsequent Hospitalization or Observation Unit Admission

Abstract

Background: Although the majority of hospitalizations for heart failure (HF) originate in the emergency department (ED), many of these patients might be adequately treated and released in the ED or managed for a short period in an observation unit. Both ED and observation management have been shown to reduce costs and avoid the penalties related to rehospitalization. The purpose of this study was to examine trends in ED visits for HF and disposition following these visits. Because of increasing policy pressure to reduce rehospitalization for HF, we hypothesized that the number of HF patients hospitalized by ED providers decreased over time with a concurrent increase in admissions to the observation unit. We further hypothesized that the overall number of ED visits for HF decreased as a result of improved therapy for HF the last two decades. Methods: We used the National Hospital Ambulatory Medical Care Survey (NHAMCS) to estimate rates and characteristics of ED visits for HF 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 HF remained stable over the period, from 914,739 in 2002 to 848,634 in 2010 (annual change -0.7%; 95% CI -3.7% - +2.5%). Of these visits, 74.2% led to hospitalization while 3.1% led to observation unit admission (Figure). The likelihood of hospitalization did not change during the period (adjusted prevalence ratio (aPR) 1.00; 95% CI 0.99-1.01 for each additional year) while admission to observation increased annually (aPR 1.11; 95% CI 1.00-1.23). We observed significant regional differences: as compared to other regions, patients in the Northeast were more likely to be hospitalized (aPR 1.15; 95% CI 1.07-1.22) but less likely to be admitted to an observation unit (aPR 0.43; 95% CI 0.19-1.02). Conclusions: The number of ED visits for HF has remained stable in the last decade. Although observation unit admissions increased during this period, they constituted a relatively small number of dispositions and did not appear to attenuate the substantial number of ED visits that resulted in hospitalization. Opportunities may exist to reduce hospitalizations by increasing short term management of HF in the observation unit.