title: The burden of acute heart failure on U.S. emergency departments.
abstract: OBJECTIVE
  The goal of this study was to examine 2006 to 2010 emergency department (ED) admission rates, hospital procedures, lengths of stay, and costs for acute heart failure (AHF).
  
  
  BACKGROUND
  Patients with AHF are often admitted and are associated with high readmissions and cost.
  
  
  METHODS
  We utilized Nationwide Emergency Department Sample AHF data from 2006 to 2010 to describe admission proportion, hospital length of stay (LOS), and ED charges as a surrogate for resource utilization. Results were compared across U.S. regions, patient insurance status, and hospital characteristics.
  
  
  RESULTS
  There were 958,167 mean yearly ED visits for AHF in the United States. Fifty-one percent of the patients were female, and the median age was 75.1 years (interquartile range [IQR]: 62.5 to 83.7 years). Overall, 83.7% (95% confidence interval: 83.1% to 84.2%) were admitted; the median LOS was 3.4 days (IQR: 1.9 to 5.8 days). Comparing 2006 with 2010, there was a small decrease in median LOS (0.09 days), but the proportion admitted did not change. Odds of admission, adjusting for age, sex, hospital characteristic (academic and safety net status), and insurance (Medicare, Medicaid, private, self-pay/no charge) were highest in the Northeast. Median ED charges were $1,075 (IQR: $679 to $1,665) in 2006 and $1,558 (IQR: $1,018 to $2,335) in 2010. Patients without insurance were more likely to be discharged from the ED, but when admitted, were more likely to receive a major diagnostic or therapeutic procedure.
  
  
  CONCLUSIONS
  A very high proportion of ED patients with AHF are admitted nationally, with significant variation in disposition and procedural decisions based on region of the country and type of insurance, even after adjusting for potential confounding.
authors: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee. Electronic address: alan.storrow@vanderbilt.edu.
authors: Alan B
authors: AB
authors: Storrow
authors: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors: Cathy A
authors: CA
authors: Jenkins
authors: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors: Wesley H
authors: WH
authors: Self
authors: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors: Pauline T
authors: PT
authors: Alexander
authors: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors: Tyler W
authors: TW
authors: Barrett
authors: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors: Jin H
authors: JH
authors: Han
authors: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors: Candace D
authors: CD
authors: McNaughton
authors: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors: Benjamin S
authors: BS
authors: Heavrin
authors: Center for Cardiovascular Innovation, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors: Mihai
authors: M
authors: Gheorghiade
authors: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors: Sean P
authors: SP
authors: Collins
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006333:Heart Failure / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: emergency medicine; heart failure; resource utilization