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Acute heart failure patients not receiving adequate outpatient care

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A recent study has found that almost one-third of acute heart failure syndrome (AHFS) patients who sought care in emergency departments (EDs) in two states were seen for the same diagnosis in the previous year, indicating patients aren’t receiving adequate followup care.

AHFS is an increase in symptoms of heart failure that requires immediate care.

“The high proportion of patients with frequent ED visits reflects the failure of current measures to manage heart failure symptoms,” says Kohei Hasegawa, MD, MPH, MGH Department of Emergency Medicine, and author of the report. “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 pre-admission ED visits.”

The authors write that AHFS accounts for more than 675,000 ED visits and one million hospitalizations in the United States annually, which costs about $31 million. Many ED visits can be prevented through “high-quality outpatient care,” according to information provided by Massachusetts General Hospital.

The researchers looked at data from Florida and California databases regarding ED visits and inpatient admissions during 2010 and 2011. Of the more than 113,000 adult patients with at least one ED visit for AHFS during 2010, almost 70 percent did not return for a visit over the next year. However, almost 34,800 patients, or 30 percent, returned to the ED because of AHFS at least once in the following year.

Those patients were more likely to be:

  • black
  • Hispanic
  • on Medicaid
  • or low-income.

The AHFS patients with frequent ER visits accounted for more than half of all heart failure ED visits. Additionally, more than 86 percent of these ED visits led to hospitalizations, accounting for more than half of all heart failure hospitalizations.
Hasegawa says the solution is providing “high-quality outpatient care” in these patients.

“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 $1 billion in Florida alone,” says Hasegawa.

He also says it is no coincidence that low-income people tend to use the ED more for AHFS care.

“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, but we need further studies of the role of these factors to develop better preventive measures,” he concludes.

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