TY - JOUR
T1 - Health care utilization among adenosine-sensitive supraventricular tachycardia patients presenting to the emergency department
AU - Dewland, Thomas A.
AU - Oesterle, Adam
AU - Stein, John
AU - Marcus, Gregory M.
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media New York.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Purpose: Although adenosine-sensitive supraventricular tachycardia (SVT) is generally curable, it remains an important cause of healthcare utilization. We sought to determine predictors of health care utilization among SVT patients presenting to the emergency department (ED). Methods: We studied consecutive patients evaluated in an urban, academic ED for adenosine-sensitive SVT. The primary study outcomes were (1) ambulance transportation to the index ED visit, (2) hospital admission from the index ED encounter, and (3) recurrent SVT-associated ED encounters. Results: Among 100 patients with adenosine-sensitive SVT, 35 were transported to the ED by ambulance. Prior electrophysiologist evaluation was associated with a significant 87% reduced odds of ambulance utilization (OR 0.13, 95% CI 0.03–0.67, p = 0.015). A total of 62 patients were subsequently admitted to the hospital. All patients with coronary artery disease, diabetes, syncope, and wide complex SVT were admitted. Similarly, individuals with an elevated troponin had a significantly greater odds of hospital admission (OR 16.8, 95% CI 1.9–148.4, p = 0.011). After the index ED visit, 60 patients were seen by an electrophysiologist, and 47 underwent catheter ablation. Individuals treated with catheter ablation had a significant 75% reduction in the risk of a recurrent ED visit for SVT (HR 0.25, 95% CI 0.10–0.62, p = 0.003). Conclusions: Readily modifiable clinical factors, including a previous visit to an electrophysiologist and treatment with catheter ablation, are associated with reduced health care utilization among patients presenting to the ED with SVT.
AB - Purpose: Although adenosine-sensitive supraventricular tachycardia (SVT) is generally curable, it remains an important cause of healthcare utilization. We sought to determine predictors of health care utilization among SVT patients presenting to the emergency department (ED). Methods: We studied consecutive patients evaluated in an urban, academic ED for adenosine-sensitive SVT. The primary study outcomes were (1) ambulance transportation to the index ED visit, (2) hospital admission from the index ED encounter, and (3) recurrent SVT-associated ED encounters. Results: Among 100 patients with adenosine-sensitive SVT, 35 were transported to the ED by ambulance. Prior electrophysiologist evaluation was associated with a significant 87% reduced odds of ambulance utilization (OR 0.13, 95% CI 0.03–0.67, p = 0.015). A total of 62 patients were subsequently admitted to the hospital. All patients with coronary artery disease, diabetes, syncope, and wide complex SVT were admitted. Similarly, individuals with an elevated troponin had a significantly greater odds of hospital admission (OR 16.8, 95% CI 1.9–148.4, p = 0.011). After the index ED visit, 60 patients were seen by an electrophysiologist, and 47 underwent catheter ablation. Individuals treated with catheter ablation had a significant 75% reduction in the risk of a recurrent ED visit for SVT (HR 0.25, 95% CI 0.10–0.62, p = 0.003). Conclusions: Readily modifiable clinical factors, including a previous visit to an electrophysiologist and treatment with catheter ablation, are associated with reduced health care utilization among patients presenting to the ED with SVT.
KW - Adenosine
KW - Catheter ablation
KW - Emergency department
KW - Healthcare utilization
KW - SVT
KW - Supraventricular tachycardia
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U2 - 10.1007/s10840-017-0259-1
DO - 10.1007/s10840-017-0259-1
M3 - Article
C2 - 28600671
AN - SCOPUS:85020623556
SN - 1383-875X
VL - 49
SP - 103
EP - 109
JO - Journal of Interventional Cardiac Electrophysiology
JF - Journal of Interventional Cardiac Electrophysiology
IS - 2
ER -