Acuity patterns of heart failure among emergency departments in a large health system

Background: The prognostic importance of Emergency Heart Failure Mortality Risk Grade (EHMRG) score in assessing short term mortality in Congestive Heart Failure (CHF) patients has been validated in the past, however, few studies have examined acuity patterns in the CHF population across healthcare settings. We aim to understand acuity patterns of CHF patients across a large health system for better resource utilization.

Methods: Retrospective chart review of adult patients with acute CHF in a large Metropolitan health system was performed in 3 community and 3 academic hospitals between January 2014 and January 2016. We collected demographic data, setting type, and calculated EHMRG score. Descriptive analysis of each hospital and mixed-effects negative binomial models were created to see patterns of acuity versus hospital volume.

Results: A total of 3312 Emergency Department (ED) visits among 2490 unique patients were included. Academic and community hospitals had 2168 patients and 1144 patients, respectively. Hospitals with higher volume treated a large amount of lower acuity patients. Academic hospitals had 30% of CHF ED visits in the lowest EHMRG quantile versus 20% at community hospital (p < 0.0001). Compared to EHMRG quantile 5b, hospital volume was 17%, 8% and 5% higher in quantile 1, 2, and 3 with a p-value less than 0.05 (IRR = 1.17; 1.08;1.05), respectively, but were not significant compared to quantile 4 and 5a. Revisit rates were lower in academic hospitals; admission rates were lower in community hospitals.

Conclusion: Academic hospitals had a higher number of Acute Heart Failure (AHF) patients, larger number of low acuity patients, higher admission rates, but less revisit rates to the ED as compared to community hospitals. We suggest acuity specific interventions will help decrease admission and revisit rates.