Epidemiology of heart failure in the emergency department

Abstract

Study objectives: Most of the heart failure literature discusses epidemiology and treatment in terms of the chronic patient with heart failure. We describe the prevalence, characteristics, and pharmacotherapeutic profile of emergency department (ED) patients with heart failure. Methods: We analyzed data from the 1997 to 2000 National Hospital Ambulatory Medical Survey, a probability sample of ED visits in the United States. Heart failure was defined as a discharge diagnosis recorded as International Classification of Diseases, Ninth Revision, Clinical Modification codes of 428.0 (congestive heart failure), 428.1 (left heart failure), or 428.9 (heart failure, unspecified). Only patients with the primary diagnosis of heart failure were included. Descriptive statistics and univariate analysis were calculated using SAS software (version 8.02). Results: From 1997 to 2000, approximately 4.6 million ED patients were diagnosed with heart failure, 2.8 million of whom had the primary diagnosis of heart failure (0.69% of overall visits). Mean age was 73.5 years compared with 35.1 years for non–heart failure patients (P<.0001); 78.9% of the patients were older than 65 years, 55.1% were female, and 81.5% white; 93.2% had Medicare, Medicaid, or private insurance; 3.4% of heart failure patients were self-pay compared with 16.4% of non–heart failure patients (P<.0001); 81.2% received an ECG, 53.3% were monitored while in the ED, and 76.2% had a chest radiograph. One percent required endotracheal intubations, and 1.6% died while in the ED. Admission rate for heart failure patients was 72.3%; 20.0% of these patients required an ICU admission. Heart failure was the third most common admission diagnosis to the ICU and fifth most common admission diagnosis overall. The most common classes of medications used include diuretics (30.4%), nitrates (8.9%), and bronchodilators (6.8%). Morphine (2.4%) and angiotensin-converting enzyme inhibitors (2.4%) were used infrequently. Admitted patients with heart failure had a similar pharmacotherapeutic profile. Conclusion: As the 65 years and older age group increases, so will the number of ED visits for heart failure. The range in diagnostic and treatment modalities for heart failure is wide. Future ED studies should aim to define clinical guidelines that optimize the ED care of heart failure patients, prevent underuse of therapeutic interventions, and decrease ICU admissions. Study objectives: Most of the heart failure literature discusses epidemiology and treatment in terms of the chronic patient with heart failure. We describe the prevalence, characteristics, and pharmacotherapeutic profile of emergency department (ED) patients with heart failure. Methods: We analyzed data from the 1997 to 2000 National Hospital Ambulatory Medical Survey, a probability sample of ED visits in the United States. Heart failure was defined as a discharge diagnosis recorded as International Classification of Diseases, Ninth Revision, Clinical Modification codes of 428.0 (congestive heart failure), 428.1 (left heart failure), or 428.9 (heart failure, unspecified). Only patients with the primary diagnosis of heart failure were included. Descriptive statistics and univariate analysis were calculated using SAS software (version 8.02). Results: From 1997 to 2000, approximately 4.6 million ED patients were diagnosed with heart failure, 2.8 million of whom had the primary diagnosis of heart failure (0.69% of overall visits). Mean age was 73.5 years compared with 35.1 years for non–heart failure patients (P<.0001); 78.9% of the patients were older than 65 years, 55.1% were female, and 81.5% white; 93.2% had Medicare, Medicaid, or private insurance; 3.4% of heart failure patients were self-pay compared with 16.4% of non–heart failure patients (P<.0001); 81.2% received an ECG, 53.3% were monitored while in the ED, and 76.2% had a chest radiograph. One percent required endotracheal intubations, and 1.6% died while in the ED. Admission rate for heart failure patients was 72.3%; 20.0% of these patients required an ICU admission. Heart failure was the third most common admission diagnosis to the ICU and fifth most common admission diagnosis overall. The most common classes of medications used include diuretics (30.4%), nitrates (8.9%), and bronchodilators (6.8%). Morphine (2.4%) and angiotensin-converting enzyme inhibitors (2.4%) were used infrequently. Admitted patients with heart failure had a similar pharmacotherapeutic profile. Conclusion: As the 65 years and older age group increases, so will the number of ED visits for heart failure. The range in diagnostic and treatment modalities for heart failure is wide. Future ED studies should aim to define clinical guidelines that optimize the ED care of heart failure patients, prevent underuse of therapeutic interventions, and decrease ICU admissions.