title: Frequent utilization of the emergency department for acute heart failure syndrome: a population-based study.
abstract: BACKGROUND
  Although most research on patients with acute heart failure syndrome (AHFS) has focused on readmissions, this may provide an incomplete picture of health-care utilization. We examined the proportion and characteristics of patients with frequent emergency department (ED) visits for AHFS and associated health-care utilization.
  
  
  RESULTS
  A retrospective cohort study of adults with at least 1 ED visit for AHFS between 2010 and 2011 was performed, derived from population-based multipayer data of state ED and inpatient databases for 2 large and diverse states, California and Florida. The analytic sample comprised 113 033 patients with 175 491 ED visits for AHFS. During the 1-year follow-up period, 30.8% of patients had ≥2 (frequent) visits, accounting for 55.4% (95% confidence interval, 55.2-55.5%) of all ED visits for AHFS. In the multivariable model, significant predictors of frequent ED visits were non-Hispanic black race, Hispanic ethnicity, Medicaid insurance, and lower median household income (all P<0.001). At the visit level, patients with frequent ED visits accounted for 55.0% (95% confidence interval, 54.8-5.3%) of all AHFS hospitalizations via ED. Total charges for AHFS were $3.08 billion (95% confidence interval, $3.03-3.14 billion) in Florida alone; patients with frequent ED visits accounted for 53.3% of total charges (95% confidence interval, 53.2-53.3%).
  
  
  CONCLUSIONS
  In this large cohort study, we found that one third (31%) of ED patients with AHFS had frequent ED visits for this condition and that minority race/ethnicity and lower socioeconomic status were associated with frequent ED visits. Individuals with frequent ED visits accounted for the majority of ED visits, hospitalizations, and hospital charges.
authors.affiliation: From the Department of Emergency Medicine, Massachusetts General Hospital, Boston (K.H., C.A.C., D.F.M.B.); Harvard Medical School, Boston, MA (K.H., C.A.C., D.F.M.B.); and Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.). khasegawa1@partners.org.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: From the Department of Emergency Medicine, Massachusetts General Hospital, Boston (K.H., C.A.C., D.F.M.B.); Harvard Medical School, Boston, MA (K.H., C.A.C., D.F.M.B.); and Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.).
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tsugawa
authors.affiliation: From the Department of Emergency Medicine, Massachusetts General Hospital, Boston (K.H., C.A.C., D.F.M.B.); Harvard Medical School, Boston, MA (K.H., C.A.C., D.F.M.B.); and Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.).
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: From the Department of Emergency Medicine, Massachusetts General Hospital, Boston (K.H., C.A.C., D.F.M.B.); Harvard Medical School, Boston, MA (K.H., C.A.C., D.F.M.B.); and Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.).
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D010342:Patient Acceptance of Health Care; D011203:Poverty; D012008:Recurrence; D012189:Retrospective Studies; D013577:Syndrome; D055815:Young Adult
keywords: emergency service, hospital; epidemiology; heart failure; recurrence